A 29-year-old woman comes to the office due to painful sores on her labia. The patient first noticed the sores 3 days ago and has not had these symptoms before. She has also had a headache and intermittent fever for the past 5 days that temporarily resolved with acetaminophen. The patient recently became sexually active with a new male partner and uses a progestin-containing intrauterine device for contraception. She has no chronic medical conditions and takes no medications. Temperature is 38.4 C (101.2 F), blood pressure is 110/70 mm Hg, and pulse is 88/min. Physical examination shows several clusters of multiple small, vesicular lesions on the right labium minora and tender, right inguinal lymphadenopathy. Speculum examination is normal. Urine pregnancy test is negative. If left untreated, this patient's clinical course would most likely result in which of the following?

Question

A 29-year-old woman comes to the office due to painful sores on her labia.  The patient first noticed the sores 3 days ago and has not had these symptoms before.  She has also had a headache and intermittent fever for the past 5 days that temporarily resolved with acetaminophen.  The patient recently became sexually active with a new male partner and uses a progestin-containing intrauterine device for contraception.  She has no chronic medical conditions and takes no medications.  Temperature is 38.4 C (101.2 F), blood pressure is 110/70 mm Hg, and pulse is 88/min.  Physical examination shows several clusters of multiple small, vesicular lesions on the right labium minora and tender, right inguinal lymphadenopathy.  Speculum examination is normal.  Urine pregnancy test is negative.  If left untreated, this patient's clinical course would most likely result in which of the following?

Quizplus · Accepted Answer

11ec25c8_d9c3_88c2_bc81_ef80fa984365_MD0003_00 This patient's painful, vesicular lesions with associated tender lymphadenopathy are due to genital herpes simplex virus (HSV) infection. Primary HSV outbreaks are often associated with systemic symptoms (eg, fever, headache), more painful lesions that persist for a longer duration, and concomitant urinary retention. Without treatment, most immunocompetent patients with primary HSV have spontaneous resolution of symptoms within a week. However, many patients will experience disease recurrence, particularly during the first year after primary infection. Afterward, recurrence becomes less frequent due to improved cell-mediated immunity. Antivirals (eg, acyclovir, valacyclovir) are used to reduce symptom duration and frequency of recurrences but do not eliminate recurrences. (Choice A) Development of a maculopapular rash that includes the palms and soles occurs in secondary syphilis. In contrast to this patient, those with primary syphilis have a single, painless ulcer (ie, chancre) with bilateral, tender, inguinal lymphadenopathy. (Choice B) Inflammation of the liver capsule and resultant perihepatitis (ie, Fitz-Hugh-Curtis syndrome) occurs secondary to Chlamydia trachomatis serovars A-K and Neisseria gonorrhoeae infection. Patients with either infection can have systemic symptoms (eg, fever) when associated with pelvic inflammatory disease; however, neither infection causes vulvar lesions. (Choice C) Persistent lesions with no additional sequelae can occur with condyloma acuminata (ie, genital warts) from human papillomavirus infection. Condyloma acuminata are sexually transmitted but appear as nonpainful, pedunculated, verrucous lesions rather than painful vesicles. (Choice D) In contrast to this patient, immunosuppressed patients have more frequent, severe recurrences that progress to CNS complications (eg, aseptic meningitis, transverse myelitis). (Choice F) Suppuration of inguinal lymph nodes and formation of buboes can develop with lymphogranuloma venereum (C trachomatis serovars L1-3) or chancroid (Haemophilus ducreyi). Chancroid typically produces ulcers with a yellow-gray exudate, and lymphogranuloma venereum typically produces painless ulcers-neither of which are seen in this patient. Educational objective: Herpes simplex virus (HSV) infection typically resolves spontaneously within a week of lesion development. However, HSV is associated with recurrent disease, which can become less frequent over time. Antivirals (eg, acyclovir, valacyclovir) are used to decrease symptom duration and the number of recurrences. References: Genital herpes: a review. (http://www.ncbi.nlm.nih.gov/pubmed/27281837) Interventions for men and women with their first episode of genital herpes. (http://www.ncbi.nlm.nih.gov/pubmed/27575957)

A 29-Year-Old Woman Comes to the Office Due to Painful