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