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ANSWER 4
(4) PCR for HSV
SALIENT POINTS:
Given the fairly classical clinical presentation and the lack of travel, the most likely diagnosis is primary HSV infection.
Although syphilis is not ruled out with 100% certainty, it is much less likely because the lesion was painful.
The most sensitive diagnostic test would be PCR of a swab from lesion.
Tzanck smears are less sensitive and less specific.
Culture for HSV infection has ~70% sensitivity, so a negative culture result would not rule out the diagnosis.
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