{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,4]],"date-time":"2026-09-04T01:38:12Z","timestamp":1788485892806,"version":"build-2803163510"},"reference-count":12,"publisher":"Michigan State University College of Osteopathic Medicine Statewide Campus System","issue":"1","license":[{"start":{"date-parts":[[2026,8,27]],"date-time":"2026-08-27T00:00:00Z","timestamp":1787788800000},"content-version":"unspecified","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"abstract":"<jats:sec id=\"background\">\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Herpes simplex virus type 2 (HSV-2) is a highly prevalent sexually transmitted infection (STI), affecting approximately 13% of the global population. While classic presentations involve painful vesicular clusters, HSV-2 can present atypically or trigger immune-mediated reactions like erythema multiforme (EM). These polymorphic presentations can mimic other STIs, particularly secondary syphilis, leading to diagnostic momentum and delayed appropriate therapy.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"case-presentation\">\n                    <jats:title>Case presentation<\/jats:title>\n                    <jats:p>A 47-year-old male with a history of recurrent genital ulcers presented to the emergency department with worsening penile lesions, anal pain, and a new onset rash on his palms and soles. He had been treated for presumed syphilis two months prior. Examination revealed vesiculopustular genital lesions, inguinal lymphadenopathy, perianal ulcers resembling fissures, and targetoid lesions on the extremities. The clinical triad of genital ulcers, anal pathology, and a palmoplantar rash strongly suggested secondary syphilis. However, syphilis serology returned negative. Polymerase chain reaction (PCR) testing confirmed HSV-2. The acral rash was diagnosed as EM secondary to HSV.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"diagnosis-and-outcome\">\n                    <jats:title>Diagnosis and Outcome<\/jats:title>\n                    <jats:p>The patient was diagnosed with HSV-2 proctitis and HSV-associated erythema multiforme. He was treated with high-dose valacyclovir. At the two-week follow-up, genital and anal lesions had healed, and the systemic rash had resolved.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"conclusion\">\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>HSV-associated erythema multiforme can produce a clinical picture indistinguishable from secondary syphilis. Emergency clinicians must maintain a broad differential for genital ulcers with acral rashes. PCR testing is superior to syndromic diagnosis in complex presentations to prevent unnecessary antibiotic exposure and ensure timely antiviral management.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.51894\/001c.165152","type":"journal-article","created":{"date-parts":[[2026,8,27]],"date-time":"2026-08-27T16:05:01Z","timestamp":1787846701000},"source":"Crossref","is-referenced-by-count":1,"title":["Polymorphic mimicry - When Herpes Isn\u2019t Just Herpes: Genital Herpes Mimicking Secondary Syphilis: A Case Report"],"prefix":"10.51894","volume":"11","author":[{"given":"Andrew","family":"Vierra","sequence":"first","affiliation":[{"name":"McLaren Oakland Hospital, Pontiac, MI, USA","department":["Emergency Medicine Residency Program"]},{"name":"Michigan State University, East Lansing MI, USA","department":["College of Osteopathic Medicine"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Leena","family":"Jamal","sequence":"additional","affiliation":[{"name":"Michigan State University, East Lansing MI, USA","department":["College of Osteopathic Medicine"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Khadijah","family":"Bokhari","sequence":"additional","affiliation":[{"name":"McLaren Oakland Hospital, Pontiac, MI, USA","department":["Emergency Medicine Residency Program"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Adam","family":"Makki","sequence":"additional","affiliation":[{"name":"McLaren Oakland Hospital, Pontiac, MI, USA","department":["Emergency Medicine Residency Program"]},{"name":"Michigan State University, East Lansing MI, USA","department":["College of Osteopathic Medicine"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Taylor","family":"Liebert","sequence":"additional","affiliation":[{"name":"McLaren Oakland Hospital, Pontiac, MI, USA","department":["Emergency Medicine Residency Program"]},{"name":"Michigan State University, East Lansing MI, USA","department":["College of Osteopathic Medicine"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5456-9604","authenticated-orcid":true,"given":"Abdullah","family":"Bokhari","sequence":"additional","affiliation":[{"id":[{"id":"https:\/\/ror.org\/05tjan294","id-type":"ROR","asserted-by":"publisher"}],"name":"McLaren Health Care","department":["Emergency Medicine"]},{"id":[{"id":"https:\/\/ror.org\/05hs6h993","id-type":"ROR","asserted-by":"publisher"}],"name":"Michigan State University","department":["College of Osteopathic Medicine"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"29343","published-online":{"date-parts":[[2026,8,27]]},"reference":[{"issue":"1","key":"ref1","doi-asserted-by":"publisher","first-page":"1","DOI":"10.5070\/D37V35W30D","article-title":"Herpes simplex virus (HSV) associated erythema multiforme (HAEM): a viral disease with an autoimmune component","volume":"9","author":"L. Aurelian","year":"2003","journal-title":"Dermatol Online J"},{"issue":"4","key":"ref2","doi-asserted-by":"publisher","first-page":"1","DOI":"10.15585\/mmwr.rr7004a1","article-title":"Sexually Transmitted Infections Treatment Guidelines, 2021","volume":"70","author":"K. A. Workowski","year":"2021","journal-title":"MMWR Recomm Rep"},{"key":"ref3","article-title":"OMT Review: A Comprehensive Review in Osteopathic Medicine","author":"R. G. Savarese","year":"2003","edition":"3"},{"issue":"304","key":"ref4","first-page":"1","article-title":"Prevalence of Herpes Simplex Virus Type 1 and Type 2 in Persons Aged 14\u201349: United States, 2015\u20132016","author":"G. McQuillan","year":"2018","journal-title":"NCHS Data Brief"},{"issue":"8","key":"ref5","doi-asserted-by":"publisher","first-page":"889","DOI":"10.1111\/j.1365-4632.2011.05348.x","article-title":"Clinical features, diagnosis, and treatment of erythema multiforme: a review for the practicing dermatologist","volume":"51","author":"O. 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