A 39-year-old male with Human immunodeficiency virus (HIV) on antiretrovirals for sixteen years presented with multiple, recurrent, painful, non- indurated ulcers of size 0.5 × 0.5 cm to 1 × 1 cm on penile shaft for 8 months [Figure 1a]. Ulcers partially improved with 7 days course of oral acyclovir (400mg three times a day), only to recur again in three weeks. CD4 count was 432/mm3 and viral-load was not detectable. Biopsy showed non-specific changes. Polymerase chain reaction on a swab taken from an ulcer base was positive for Varicella zoster virus. Serology (IgG and IgM) for Herpes simplex virus 1 and 2 was negative. A diagnosis of persistent genital herpes zoster was made.[1,2] Treatment with oral acyclovir 800 mg five times-a-day for 10 days resulted in dramatic improvement with complete resolution of ulcers without any recurrence at 3-month follow-up [Figure 1b].
Figure 1.
(a) Clinical image showing multiple small punched out ulcers coalescing to form large ulcers of maximum dimension of 1 cm present on shaft of penis. Note the necrotic slough on the floor. (b) Image showing complete healing of the ulcer with white atrophic scar.
Declaration of patient consent
The authors certify that they have obtained all appropriate patient consent forms. In the form the patient has given his consent for his images and other clinical information to be reported in the journal. The patient understands that his name and initials will not be published and due efforts will be made to conceal his identity, but anonymity cannot be guaranteed.
Conflicts of interest
One of the authors is a member of the editorial board of the journal. The manuscript was subject to journal’s standard procedure and peer review was held independently of the editor or their research group.
Use of artificial intelligence (AI)
There has been no use of any kind of artificial intelligence (AI) in the preparation of this manuscript.
Acknowledgement
We thank Bhukampa Acharya MD for management of the patient and Dr Arnab Ghosh for processing the viral polymerase chain reaction.
Funding Statement
Nil.
References
- 1.Magdaleno-Tapial J, Hernández-Bel P, Ortiz-Salvador JM, López-Martí C, Martínez-Doménech Á, García-Legaz-Martínez M, et al. Genital herpes zoster: A rare location that mimic genital herpes. Sex Transm Dis. 2022;49((1)):E34–6. doi: 10.1097/OLQ.0000000000001465. [DOI] [PubMed] [Google Scholar]
- 2.Kalantzi S, Alexakis C, Anagnostaki ME, Anagnostaki I, Zacharis K. Genital herpes zoster: A report of a rare case. Cureus. 2024;16((10)):e72290. doi: 10.7759/cureus.72290. [DOI] [PMC free article] [PubMed] [Google Scholar]