Not Always the Herpes You Think: A Case Report of Genital Zoster

Herpes zoster (HZ), caused by reactivation of the varicella-zoster virus (VZV), is a common viral infection typically presenting with characteristic dermatological findings. However, less typical manifestations, such as genital zoster, are frequently overlooked. This is often due to the higher prevalence of herpes simplex virus (HSV) infections in the genital region, which can lead to diagnostic confusion. Clinicians should maintain a high index of suspicion for genital zoster, particularly in patients with dermatomal rashes or those who are immunocompromised. Accurate diagnosis is essential, as misdiagnosing genital zoster as HSV can result in unnecessary psychological distress and prolonged prophylactic antiviral treatment for some patients. Improved clinical awareness and diagnostic precision can lead to better physical and psychological outcomes for patients. This case report highlights a missed diagnosis of genital zoster, ultimately confirmed by polymerase chain reaction (PCR) testing for VZV, and underscores the importance of considering this condition in the differential diagnosis of genital symptoms, especially in patients with relevant risk factors and clinical features suggestive of zoster.