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A 32-year-old man presents with complains of a 1-week history of multiple painful vesicles on the shaft of his penis associated with tender groin adenopathy (Figure 129-1). The vesicles broke 2 days ago and the pain has increased. He had similar lesions 1 year ago but never went for healthcare examination at that time. He has had 3 different female sexual partners in the last 2 years but has no knowledge of them having any sores or diseases. He was given the presumptive diagnosis of genital herpes and a course of acyclovir. His herpes culture came back positive and his rapid plasma reagin (RPR) and HIV tests were negative.

Figure 129-1

Recurrent genital herpes simplex virus on the penis showing grouped ulcers (deroofed vesicles). (Courtesy of Richard P. Usatine, MD.)

Herpes simplex virus (HSV) infection can involve the skin, mucosa, eyes and central nervous system. HSV establishes a latent state followed by viral reactivation and recurrent local disease. Perinatal transmission of HSV can lead to significant fetal morbidity and mortality.

HSV affects more than one-third of the world's population, with the 2 most common cutaneous manifestations being genital (Figures 129-1, 129-2, 129-3, 129-4) and orolabial herpes (Figures 129-5, 129-6, 129-7).1

Figure 129-2

Herpes simplex on the penis with intact vesicles and visible crusts. (Courtesy of Jack Rezneck, Sr., MD.)

Figure 129-3

Vulvar herpes simplex virus at the introitus showing small punched out ulcers. (Courtesy of the Centers for Disease Control and Prevention and Susan Lindsley.)

Figure 129-4

Recurrent herpes simplex virus on the buttocks of a woman in the ulcerative stage. Women are prone to getting buttocks involvement owing to sleeping with partners that have genital involvement. (Courtesy of Richard P. Usatine, MD.)

Figure 129-5

Primary herpes gingivostomatitis in a teenager presenting with multiple ulcers on the tongue and lower lip. (Courtesy of Richard P. Usatine, MD.)

Figure 129-6

Close-up of recurrent herpes simplex virus-1 showing vesicles on a red base at the vermillion border in a young girl. (Courtesy of Richard P. Usatine, MD.)

Figure 129-7

Orolabial herpes simplex virus in an adult woman showing deroofed blisters (ulcer). (Courtesy of Richard P. Usatine, MD.)

The Centers for Disease Control and Prevention (CDC) reports that at least 50 million persons in ...

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