A 54-year-old man sought medical attention due to the acute onset of a painful scrotal rash. He had never experienced anything similar. The patient was a traveling salesman and was concerned that the lesions were bedbug bites.
Key point: Examination revealed grouped, crusted erosions on the scrotal skin. The patient also had ipsilateral, tender inguinal adenopathy. The diagnosis of herpes (HSV-2) infection was confirmed by viral “culture.” While routine culture would not be expected to be successful when crusting has already developed, almost all laboratories actually now perform (more sensitive) PCR on specimens submitted for herpes “culture.”
Treatment: Valacyclovir was administered in a dose of 1000 mg, twice daily, for 10 days.
Note: The high dose of valacyclovir was prescribed because this appeared to be an initial outbreak. Long-term prophylactic antiviral therapy would be offered if recurrences are frequent or very severe.