Snapshot A 22-year-old man presents to an urgent care clinic for a severe painful genital ulcer. His symptoms are associated with fever, headache, myalgias, and dysuria. He has a medical history of asthma. Social history is significant for having multiple recent sexual partners while not using condoms. Physical examination is significant for a genital ulcer with associated tender inguinal lymphadenopathy. A polymerase chain reaction returns positive for HSV2 infection. Introduction Classification an enveloped, linear, double-stranded DNA virus from the Herpesviridae family Epidemiology incidence most cases of recurrent genital herpes are caused by HSV2 Transmission sexual contact perinatal Pathogenesis HSV2 inoculates in the mucous membrane or skin after close contact with the skin or genital secretions of a patient with viral shedding cytolytic replication occurs in the epithelial cells where the virus enters, which then travels to the sensory dorsal root ganglia, where it lies dormant Prognosis immunocompromised patients have more severe herpetic episodes with frequent viral reactivation Presentation Symptoms/physical exam painful genital ulcers dysuria fever inguinal lymphadenopathy Studies Making the diagnosis based on the patient's history and physical exam, which is confirmed by laboratory testing Confirmatory testing includes viral culture polymerase chain reaction (PCR) direct fluorescence antibody serological testing Tzank smear demonstrates multinucleated giant cells (intranuclear eosinophilic Cowdry A inclusions) seen in HSV1, HSV2, and VZV infections Differential Chancre differentiating factor abnormal VDRL and RPR testing Treatment Medical acyclovir, famciclovir, or valacyclovir indications immunocompromised patients patients with frequent outbreaks Complications Neonatal herpes Disseminated vesicular rash