A 19-year-old man presents to the ED with pain along his penile shaft for the past 7 days. He reports a low-grade fever and myalgias and was sexually active with a new partner 10 days ago. He denies any penile discharge or dysuria. There is no inguinal adenopathy palpated on exam, but he has tender penile lesions, revealed in the image seen above. Which of the following is most likely to be an effective treatment?

Acyclovir PO
Ceftriaxone IM
Doxycycline PO
Penicillin G IM

A. Acyclovir PO

Explanation:

This is a patient with a primary herpes infection, characterized by a low-grade fever; myalgias; and multiple painful, shallow, tender, genital lesions. These typically follow a 2-7-day incubation period. Patients often do not have adenopathy until the 2nd or 3rd week of illness. Lesions last for 2-4 weeks. Treatment is acyclovir to reduce the duration of symptoms and viral shedding.

Ceftriaxone (B) is one of several treatment regimens for chancroid. Although chancroid also presents with painful genital ulcers, 50% of patients also develop a large unilateral, fluctuant lymph node (bubo) 1 week after the ulcers appear. It is often difficult to differentiate herpes from chancroid on exam. However, herpes is orders of magnitude more common in the United States; most cases of chancroid occur in developing countries. There are usually fewer than 100 cases of chancroid reported to the CDC annually. Therefore, in patients such as this one, herpes should be of primary consideration, and acyclovir is more likely to be an effective treatment. Doxycycline (C) is used to treat lymphogranuloma venereum. However, lesions are painless and often go unnoticed. Patients often present in the secondary stage following the disappearance of genital lesions, when they develop painful lymphadenitis. Penicillin (D) would be the appropriate treatment for syphilis. However, the incubation period is typically longer and primary lesions (chancres) are painless with raised edges.

Acyclovir PO

Explanation:

According to the symptoms described this patient has herpes in its first stage, Administrating  Acyclovir PO will be an effective treatment because it is going to reduce the spread of the infection and at the same time it is going to reduce the symptoms. Acyclovir is a specific medication for the treatment of the herpes virus.    

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