A 45-year-old man seeks your advice regarding lesions on the penile shaft that have recurred four times over the preceding 6 months. He is recently divorced and has participated in unprotected sexual activity with two partners. He is concerned about possible genital herpes. Exam reveals a single lesion on the left mid-penile shaft with what appear to be dry crusted vesicles on an erythematous base. Regional lymph nodes are normal.
1. How is history helpful in the diagnosis?
2. You advise the patient that although the lesion present is in a late phase and is not diagnostic, the overall picture is consistent with genital herpes. He desires a definitive diagnosis if possible. What lab tests are indicated?
3. The rapid immunofluorescence (RIF) test for herpes is positive and confirms the presence of HSV-2, but a serologic test for syphilis is negative, as are the HIV titers. What counseling will you give the patient regarding future sexual activity?
4. What treatment is indicated for this patient?
5. If the clinical findings included one or more small painful ulcers and regional adenopathy, what would be the most likely diagnosis?
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