Question 1 - Cutaneous Manifestations Question Bank

HIV Clinical Care Question Bank

Cutaneous ManifestationsQuestion 1/10

A 56-year-old man with HIV and a CD4 count of 416 cells/mm³ presents for evaluation of several painful, ulcerated lesions on his penis and scrotum (Figure 1). The lesions have been present for about 6 days and appear to be getting worse.

Which one of the following would you recommend for treating this episode of genital herpes infection in this man?

Oral valacyclovir 1 gram twice daily for 7 days

A single 800 mg dose of oral acyclovir

A single 1-gram dose of oral famciclovir

A single 1-gram dose of oral valacyclovir

Figure 1. Ulcerated Lesions on Scrotum Caused by HSV .

Source: photograph from David H. Spach, MD

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Question Last Updated
January 28th, 2025

Table 1. **Guidelines for the Prevention and Treatment of Opportunistic Infections in Adults and Adolescents with HIV**

Recommendations for Treating Herpes Simplex Virus (HSV) Infections
Treating Genital Lesions: Initial (Duration 7-10 days) or Recurrent (Duration: 5–10 Days) Valacyclovir 1 g PO twice a day (AI), or Famciclovir 500 mg PO twice a day (AI), or Acyclovir 400 mg PO three times a day (AI)
Treating Severe Mucocutaneous HSV Infections (AIII) Initial therapy acyclovir 5 mg/kg IV q8hr After lesions begin to regress, change to oral therapy as above. Continue treatment until lesions have completely healed.
Rating of Recommendations: A = Strong; B = Moderate; C = Weak Rating of Evidence: I = Data from randomized controlled trials; II = Data from well-designed nonrandomized trials, observational cohort studies with long-term clinical outcomes, relative bioavailability/bioequivalence studies, or regimen comparisons from randomized switch studies; III = Expert opinion

Source:

Panel on Guidelines for the Prevention and Treatment of Opportunistic Infections in Adults and Adolescents with HIV. Guidelines for the prevention and treatment of opportunistic infections in adults and adolescents with HIV. National Institutes of Health, HIV Medicine Association, and Infectious Diseases Society of America. Herpes simplex virus. Last updated: July 14, 2025. [HIV.gov]

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