A 28-year-old unmarried man was dating widely, but always wore a condom during intercourse. One week after sex with a new partner, he developed a painful rash at the base of the penis.
Key point: The confluence of many small and large blisters, along with the associated pain, suggests the diagnosis of herpes progenitalis. The patient also had tender bilateral inguinal adenopathy. A Tzanck smear obtained from the base of an intact blister was positive for multinucleated giant cells. A condom can only protect what it covers; thus, the occurrence of lesions at the base of the penis, just above the barrier afforded by the condom.
Treatment: The patient received standard acyclovir dosage for first outbreak genital herpes: 200 mg orally, 5 times daily, for 10 days total.
Note: At this point, there is no way to predict how often or how severe future recurrences will be. Suppressive antiviral therapy would be offered if the patient experiences frequent or long-lasting recurrences.