A previously healthy, 26-year-old heterosexual man experienced necrotic penile ulcerations with fever, rigors, and difficulty voiding. Urethral instrumentation and treatment with antibiotics were associated with progression of the disease. Type 1 herpes simplex virus was isolated from the penile ulcerations and pustular lesions in the groin and antecubital fossae. Recovery was complicated by a urethral stricture requiring surgical treatment. Herpes simplex type 1 must be considered in the differential diagnosis of severe penile ulcerations; isolation of herpesvirus from such lesions may obviate further diagnostic and therapeutic measures that are unnecessary and, in some cases, counterproductive.
Powers RD, Rein MF, Hayden FG. Necrotizing Balanitis due to Herpes Simplex Type 1. JAMA. 1982;248(2):215-216. doi:10.1001/jama.1982.03330020059031