Brief Answer:
History and additional pictures required

Detailed Answer:
Hello,
Thank you for posting on HCM.
I can understand your concern regarding the skin lesions and I have reviewed the picture. It looks like you might have got a viral infection called Herpes but its difficult to point specific diagnosis as the picture is up very close to lesions making it difficult for me to make out the exact site of the body involved
Therefore, I insist you to post some more clinical pictures from variable distance and also describe in brief about duration of lesions, associated symptoms, sites of body involved and other relevant history so that I can help you in a better way.
You can mail pictures to YYYY@YYYY
with subject titled ' ATTN Dr Hardik Pitroda'.

Thanks
Dr Hardik Pitroda

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Brief Answer:
History required

Detailed Answer:
I have reviewed the picture but as I asked earlier you have still not provided any history.
Though this looks very much like Herpes progenitalis caused by Human simplex virus but similar lesions can be part of other condition called Herpes zoster caused by Varicella zoster virus.
While Herpes progenitalis is commonly acquired sexually, Herpes zoster on other hand is reactivation of inactive virus due to decrease in immunity.
Since the approach to management and prognosis of these conditions are highly different, its important we diagnose it accurately and for which I would require you to provide me following history:
1. Associated symptoms and any other sites affected
2. Previous history of similar lesions
3. Details of last sexual episode- known/unknown partner, condom used or not, type of sexual behaviour- vaginal/oral/both
4. History of similar lesions in your sexual partner
5.History of any immunodeficiency state like Diabetes or any major illness or surgery in recent past

Thanks
Dr Hardik Pitroda

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Brief Answer:
Oral and topical acyclovir

Detailed Answer:
It seems from the picture and history that you are having Herpes Progenitalis, a viral infection caused by Human simplex virus and it leads to multiple blisters and tiny ulcers over genitals.

I would suggest you to consult your dermatologist for proper management.

I would also advise certain investigations like HSV I and II Ig G and Ig M, VDRL and HIV antibody test as a part of protocol. Ideally your partner should also be tested in similar way.

In my patients of herpes progenitalis, I suggest oral acyclovir 400mg three times a day for 7-10 days.
Apply acyclovir ointment thrice a day for a week or so.

Herpes progenitais is notorious for recurrence and every recurrence should be actively treated with the above regimen.

If there are more than 6 recurrences in a year, I would suggest daily suppressive regimen where oral Acyclovir is taken in dose of 400mg twice a day for one year.

Whenever there are active lesions its advised to avoid any sexual activity or if so you do indulge then make sure you use barrier contraceptive like condoms.

Let me know if you require any further assistance from my side.
Thanks
Dr Hardik Pitroda

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