Significant history and physical examination findings	Laboratory findings	Treatments
Herpes simplex virus
Initial lesions are usually multiple vesicles; lesions may spontaneously rupture before clinical presentation, leaving a shallow, painful ulcer First-time infections may cause constitutional symptoms and lymphadenopathy	Definitive: Detection of herpes simplex virus DNA by nonculture methods (polymerase chain reaction) from ulcer scraping or aspiration of vesicle fluid Presumptive:  Typical lesions plus any of the following: Previously known outbreak Exclusion of other causes of ulcers	First episode (may extend treatment if not healed after 10 days):  Acyclovir, 400 mg 3 times daily for 7 to 10 days, or  Acyclovir, 200 mg 5 times daily for 7 to 10 days, or  Valacyclovir (Valtrex), 1 g twice daily for 7 to 10 days, or  Famciclovir (Famvir), 250 mg 3 times daily for 7 to 10 days Recurrent episode:  Acyclovir, 400 mg 3 times daily for 5 days, or  Acyclovir, 800 mg twice daily for 5 days, or  Acyclovir, 800 mg 3 times daily for 2 days, or  Acyclovir, 200 mg 5 times daily for 5 days, or  Valacyclovir, 500 mg twice daily for 3 days, or  Valacyclovir, 1 g daily for 5 days, or  Famciclovir, 125 mg twice daily for 5 days, or  Famciclovir, 1 g twice daily for 1 day, or  Famciclovir, 500 mg once, then 250 mg twice daily for 2 days Suppressive therapy:  Acyclovir, 400 mg twice daily, or  Acyclovir, 200 mg 3 to 5 times daily, or  Valacyclovir, 500 mg daily, or  Valacyclovir, 1 g daily, or  Famciclovir, 250 mg twice daily Severe acute disease:  Admit the patient, begin intravenous acyclovir, 5 to 10 mg per kg every 8 hours for 10 days; intravenous therapy for 2 to 7 days until improvement, then switch to oral therapy to complete 10 days of treatment
Syphilis
A single, painless, well-demarcated ulcer with a clean base and indurated borders (chancre) Mild or minimally tender inguinal lymphadenopathy Secondary syphilis is typically a nonulcerative phase (patients presenting with condyloma lata lesions) Tertiary syphilis is typically a nonulcerative phase (aortitis, gumma, and iritis) Early latent syphilis is typically a nonulcerative phase (the presence of infection less than 1 year, but time unknown) Late latent syphilis (the likely duration of infection is more than 1 year) includes other stages of syphilis but does not present during the ulcerative phase of the disease to allow for diagnosis	Identification of Treponema pallidum from a chancre or lymph node aspirate on darkfield microscopy or by direct fluorescent antibody	Primary, secondary, or latent < 1 year: Intramuscular penicillin G benzathine (600,000 units per mL), 2.4 million units in a single dose; may repeat dose after 1 week if pregnant Latent > 1 year or unknown duration or tertiary syphilis with normal cerebral spinal fluid examination:  Intramuscular penicillin G benzathine, 2.4 million units once per week for 3 weeks Any patient allergic to penicillin should undergo desensitization and then treatment with penicillin Sex partners exposed within 90 days before diagnosis should undergo treatment