Laboratory investigation for genital herpes (GH) includes serologic tests and polymerase chain reaction (PCR) with different sensitivity and specificity; occasionally, the results are not conclusive. We report a case of GH in HIV-infected patients with a non-reactive serologic test but positive PCR. A 29-years old HIV-positive man presented with multiple painful shallow ulcers with pus on his penis in the last five days. PCR examination showed a positive result, whereas anti-HSV 1 IgM, anti-HSV 2 IgM, anti-HSV 2 IgG, VDRL, and  TPHA  were  negative.  The  anti-HSV-  1  IgG  result  was  reactive  with  a  CD4  value  of  122  cells/μL. Clinical  features  of  GH  in  infected  HIV  patients  are  often  atypical  and  resemble  other  genital  ulcers,  thus  requiring  additional  investigations.  The  serologic  test  may  sometimes  present  a  false  negative,  whereas  PCR  is  much  more  sensitive and specific, nearing 100%. In patients with HIV infection, GH diagnosis at an early stage can shorten the course of the disease and prevent complication.

Dr. Jhauharina Rizki Fadhilla, Sp.DV is a Dermatologist and Venereologist. She can help with skin and genital health consultation services. She completed her education as a Specialist in Dermatology and Venereology at the University of Indonesia. She is also part of the Indonesian Association of Dermatology and Venereology Specialists (PERDOSKI).