Two HIV-positive male patients with a rarely documented form of genital herpes are described. In both cases the atypical clinical presentation suggested neoplastic rather than infectious lesions. This tumorous genital herpes may occur in HIV-infected patients while on antiretroviral therapy. Since therapeutic failure to nucleoside analogues is common in these cases even in the absence of phenotypical resistance, other treatment options are discussed.

1.
Czelusta A, Yen-Moore A, Van der Straten M, Carrasco D, Tyring SK: An overview of sexually transmitted diseases. III. Sexually transmitted diseases in HIV-infected patients. J Am Acad Dermatol 2000;43:409–432.
2.
Strick LB, Wald A, Celum C: Management of herpes simplex virus type 2 infection in HIV type 1-infected persons. Clin Infect Dis 2006;43:347–356.
3.
Siegal FP, Lopez C, Hammer GS, Brown AE, Kornfeld SJ, Gold J, et al: Severe acquired immunodeficiency in male homosexuals, manifested by chronic perianal ulcerative herpes simplex lesions. N Engl J Med 1981;305:1439–1444.
4.
Penneys NS, Hicks B: Unusual cutaneous lesions associated with acquired immunodeficiency syndrome. J Am Acad Dermatol 1985;13:845–852.
5.
Tong P, Mutasim DF: Herpes simplex virus infection masquerading as condyloma acuminata in a patient with HIV disease. Br J Dermatol 1996;134:797–800.
6.
Skinhoj P: Herpesvirus infections in the immunocompromised patient. Scand J Infect Dis Suppl 1985;47:121–127.
7.
Tyring SK, Carlton SS, Evans T: Herpes: atypical clinical manifestations. Dermatol Clin 1998;16:783–788.
8.
Maier JA, Bergman A, Ross MG: Acquired immunodeficiency syndrome manifested by chronic primary genital herpes. Am J Obstet Gynecol 1986;155:756–758.
9.
Vogel P, Smith KJ, Skeleton HG, Cuozzo D, Wagner KF: Verrucous lesions of herpes simplex in HIV-1+ patients. Military Medical Consortium for the Advancement of Retroviral Research. Int J Dermatol 1993;32:680–682.
10.
Carrasco DA, Trizna Z, Colome-Grimmer M, Tyring SK: Verrucous herpes of the scrotum in a human immunodeficiency virus-positive man: case report and review of the literature. J Eur Acad Dermatol Venereol 2002;16:511–515.
11.
Stewart JA, Reef SE, Pellett PE, Corey L, Whitley RJ: Herpesvirus infections in persons infected with human immunodeficiency virus. Clin Infect Dis 1995;21(suppl 1):S114–S120.
12.
Rosen T, Brown TJ: Genital ulcers: evaluation and treatment. Dermatol Clin 1998;16:673–685.
13.
Al Rajabi W, Venturini M, Sala R, Calzavara-Pinton P: Wegener’s granulomatosis of the penis: genital presentation of systemic disease. Dermatology 2006;212:370–372.
14.
Alpsoy E, Elpek GO, Yilmaz F, Ciftcioglu MA, Akman A, Uzun S, et al: Androgen receptor levels of oral and genital ulcers and skin pathergy test in patients with Behcet’s disease. Dermatology 2005;210:31–35.
15.
Samaratunga H, Weedon D, Musgrave N, McCallum N: Atypical presentation of herpes simplex (chronic hypertrophic herpes) in a patient with HIV infection. Pathology 2001;33:532–535.
16.
Lanzafame M, Mazzi R, Di Pace C, Trevenzoli M, Concia E, Vento S: Unusual, rapidly growing ulcerative genital mass due to herpes simplex virus in a human immunodeficiency virus-infected woman. Br J Dermatol 2003;149:216–217.
17.
Dehen L, Vilmer C: Herpes génital de présentation tumorale chez une patiente infectée par le VIH. Ann Dermatol Venereol 2006;133:393–394.
18.
Husak R, Tebbe B, Goerdt S, Wolfer LU, Zeichardt H, Stoffler-Meilicke M, et al: Pseudotumour of the tongue caused by herpes simplex virus type 2 in an HIV-1 infected immunosuppressed patient. Br J Dermatol 1998;139:118–121.
19.
Fox PA, Barton SE, Francis N, Youle M, Henderson DC, Pillay D, et al: Chronic erosive herpes simplex virus infection of the penis, a possible immune reconstitution disease. HIV Med 1999;1:10–18.
20.
French MA, Price P, Stone SF: Immune restoration disease after antiretroviral therapy. AIDS 2004;18:1615–1627.
21.
Ratnam I, Chiu C, Kandala NB, Easterbrook PJ: Incidence and risk factors for immune reconstitution inflammatory syndrome in an ethnically diverse HIV type 1-infected cohort. Clin Infect Dis 2006;42:418–427.
22.
Lehloenya R, Meintjes G: Dermatologic manifestations of the immune reconstitution inflammatory syndrome. Dermatol Clin 2006;24:549vii–570vii.
23.
Reyes M, Shaik NS, Graber JM, Nisenbaum R, Wetherall NT, Fukuda K, et al: Acyclovir-resistant genital herpes among persons attending sexually transmitted disease and human immunodeficiency virus clinics. Arch Intern Med 2003;163:76–80.
24.
Danve-Szatanek C, Aymard M, Thouvenot D, Morfin F, Agius G, Bertin I, et al: Surveillance network for herpes simplex virus resistance to antiviral drugs: 3-year follow-up. J Clin Microbiol 2004;42:242–249.
25.
Bratzke B, Orfanos CE, Stavermann T, Ehlers G: Chronisch-erosiver, therapierefraktärer perianaler Herpes (Typ II) mit Herpes Proktitis bei AIDS. Hautarzt 1991;42:96–100.
26.
Centers for Disease Control and Prevention: Sexually transmitted diseases treatment guidelines, 2006. MMWR Morb Mortal Wkly Rep 2006;55:1–93.
27.
Safrin S, Crumpacker C, Chatis P, Davis R, Hafner R, Rush J, et al; AIDS Clinical Trials Group: A controlled trial comparing foscarnet with vidarabine for acyclovir-resistant mucocutaneous herpes simplex in the acquired immunodeficiency syndrome. N Engl J Med 1991;325:551–555.
28.
Danielsen AG, Petersen CS, Iversen J: Chronic erosive herpes simplex virus infection of the penis in a human immunodeficiency virus-positive man, treated with imiquimod and famciclovir. Br J Dermatol 2002;147:1034–1036.
29.
Saint-Léger E, Fillet AM, Malvy D, Rabanel B, Caumes E: Efficacité du cidofovir dans un herpès cutané résistant à l’aciclovir et au foscarnet chez un malade séropositif pour le VIH. Ann Dermatol Venereol 2001;128:747–749.
30.
Janier M, Scieux C, Meouchi R, Tournoux C, Porcher R, Maillard A, et al: Virological, serological and epidemiological study of 255 consecutive cases of genital herpes in a sexually transmitted disease clinic of Paris (France): a prospective study. Int J STD AIDS 2006;17:44–49.
31.
Sacks SL, Shafran SD, Diaz-Mitoma F, Trottier S, Sibbald RG, Hughes A, et al: A multicenter phase I/II dose escalation study of single-dose cidofovir gel for treatment of recurrent genital herpes. Antimicrob Agents Chemother 1998;42:2996–2999.
32.
Pechère M, Wunderli W, Trellu-Toutous L, Harms M, Saurat JH, Krischer J: Treatment of acyclovir-resistant herpetic ulceration with topical foscarnet and antiviral sensitivity analysis. Dermatology 1998;197:278–280.
Copyright / Drug Dosage / Disclaimer
Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher.
Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.
You do not currently have access to this content.