2018年8月21日，接诊一例自称患单纯疱疹二型（herpes simplex virus 2 ）病人， 患病二个多月，就诊于我，要求中医治疗。我仔细询问了病史，并且检查了病人。

他诊断单纯二型疱疹，是因为二月前， 他身上起了很多丘疹。看下图，这是腿上的丘疹。

二月前去看医生，医生在他腹股沟区的丘疹上取了样品，去化验， 报告是单纯二型疱疹。下面是2018年7月2日的化验结果。

他的医生并开了处方，抗单纯疱疹病毒的药。下图为药单。

患者知道自己患了单纯二型疱疹，它可是一种性病啊，是性传染性疾病。可患者是单身，也没接触其他异性，但医生告诉他，也有通过其它方式传染。他焦虑，担心，失眠，绝望，不敢相信患了此病，无脸见人。

根据单纯二型疱疹发病特征，它主要发生在阴部的皮肤和粘膜的交界处，如龟头，阴道口周围，肛门周围， 很少发生在四肢。我看诊后又查了一些资料，很怀疑他这个“性病”的诊断。因此他第二次来诊时，果断要求他复查，检查血液，明确诊断。当天就去看他的医生，复查了血液。

结果出来后，高兴的给我打电话，说是单纯疱疹血液阴性。看下图28/08/2018的结果。

正确的诊断就是治疗，患者的焦虑、失眠、抑郁等统统消失。医生看到他的血液检查报告，开了消炎止痒的药膏，擦后皮疹也消退了，我估计是跳蚤咬的。

谢谢阅读！Published on: Sep 13, 2018 at 14:24

Case Study | Diagnosed with HSV-2, but the Clinical Picture Did Not Fit

On 21 August 2018, I saw a patient who told me he had been diagnosed with herpes simplex virus type 2, or HSV-2.

He had been living with this diagnosis for more than two months and came to see me because he wanted to try Chinese medicine treatment.

However, after taking a detailed history and examining the skin lesions, my first question was not how to treat HSV-2.

It was:

Did this diagnosis actually explain what I was seeing?

The Original Diagnosis

About two months earlier, the patient had developed multiple papules over different parts of his body, including lesions on the leg.

He had seen his doctor, and a sample was taken from a lesion in the groin area.

The laboratory report dated 2 July 2018 was interpreted as positive for HSV-2.

He was then prescribed antiviral medication.

The diagnosis had a major psychological impact on him.

He was single and believed he had not had the type of sexual exposure he associated with genital herpes. Although he had been told that transmission could occur in other ways, he remained extremely worried.

He became anxious, distressed and unable to sleep.

For him, the diagnosis itself had become almost as difficult as the skin problem.

Why I Began to Question the Diagnosis

The distribution of the skin lesions did not look typical to me.

HSV-2 most commonly affects the genital and perianal region, although clinical presentations can vary.

In this patient, however, papules were appearing more widely, including on the limbs.

That made me question whether the original diagnosis fully explained the clinical picture.

I reviewed the case again and looked at the pattern of the lesions more carefully.

At his second visit, I advised him to return to his doctor for further testing and diagnostic reassessment.

Follow-Up Testing

The patient went back for further investigation and had blood testing performed.

When the result came back, he phoned me very happily to say that the HSV-related blood test was negative.

This result did not, by itself, prove that he had never had HSV-2, because lesion testing and blood antibody testing measure different things and may not always agree.

But together with the unusual distribution of the rash, it was enough to justify reconsidering the original diagnosis.

His doctor then treated the skin lesions with an anti-inflammatory and anti-itch topical medication.

The rash subsequently settled.

At the time, I suspected that the lesions may have been caused by insect bites, possibly fleas, but this was never laboratory-confirmed.

Clinical Reflection

The most important part of this case was not that I treated HSV-2.

I did not.

The important part was recognising that the existing diagnosis did not fully match the patient’s clinical presentation.

A test result is important, but it should not replace clinical reasoning.

If the history, lesion distribution and overall presentation do not fit, the diagnosis should be reviewed rather than accepted automatically.

This case also showed how much harm an uncertain diagnosis can cause.

The patient’s anxiety, insomnia and distress were driven largely by the belief that he had a sexually transmitted infection.

Once the diagnosis was reassessed and the later results no longer supported that interpretation, his psychological burden reduced dramatically.

Sometimes the most important clinical step is not adding another treatment.

It is asking whether the diagnosis itself is correct.

Originally published: 2018
Revised for Website 2.0: 14 November 2026