Primary Genital HSV-2 Infection in a Resource-Limited Setting: Diagnostic Challenges and Clinical Implications

Herpes simplex virus type 2 (HSV-2) is a chronic sexually transmitted infection and the leading cause of genital ulcer disease worldwide. The virus establishes lifelong latency with periodic reactivation, resulting in recurrent lesions and a substantial clinical and psychosocial burden. Moreover, HSV-2 increases susceptibility to HIV infection, underscoring its global public health relevance. We report a 27-year-old male who presented to the dermatovenereology clinic with a three-day history of painful penile ulcers following recent unprotected sexual contact. Physical examination revealed multiple irregular, lenticular ulcers with erythematous bases and crusting on the corpus penis and corona glandis. The patient was alert, afebrile, and without systemic symptoms. Due to limited diagnostic resources, confirmatory testing by polymerase chain reaction (PCR) or serology was unavailable. A clinical diagnosis of primary genital HSV-2 infection was made after excluding syphilis and lymphogranuloma venereum (LGV). Treatment with oral acyclovir, cefadroxil, and mefenamic acid, supplemented by topical gentamicin and counselling on recurrence risk and safe sexual practices, led to complete lesion resolution within 14 days and no recurrence at six-week follow-up. This case highlights the dual challenge of managing HSV-2 in resource-limited settings: the lifelong, recurrent nature of the infection and the absence of confirmatory diagnostic tools. These limitations hinder accurate case identification and contribute to the underrecognition of HSV-2 prevalence. Early clinical recognition, prompt antiviral initiation, and strengthened patient education remain essential for mitigating morbidity, preventing recurrence, and reducing transmission in low-resource environments.