What treatment plan is recommended for a patient with hypercalcemia, leukocytosis, vitamin D deficiency, hypercholesterolemia, low high-density lipoprotein (HDL) cholesterol, hypoglycemia, and metabolic acidosis, presenting with a presumed genital herpes simplex virus (HSV) outbreak?

Treatment Plan for Patient with Genital HSV and Multiple Metabolic Abnormalities

For the presumed genital HSV outbreak, valacyclovir 1 gram orally twice daily for 7-10 days is the recommended first-line treatment to reduce healing time and symptoms. 1

Genital HSV Management

• Valacyclovir 1 gram orally twice daily for 7-10 days is the recommended first-line treatment for a first clinical episode of genital herpes 1
• Therapy should be initiated as soon as possible, as it is most effective when started early in the course of infection 1
• Alternative regimens include acyclovir 400 mg orally three times daily for 7-10 days or famciclovir 250 mg orally three times daily for 7-10 days 1
• Treatment may need to be extended if healing is incomplete after 10 days 1
• Patient should be counseled about the natural history of genital herpes, sexual transmission, and methods to reduce transmission 1

Vitamin D Deficiency (13.6 ng/mL)

• Vitamin D supplementation is strongly recommended for this patient with severe deficiency (13.6 ng/mL) 2
• Recommended supplementation regimen: 50,000 IU vitamin D2 or D3 weekly for 8 weeks, followed by maintenance therapy of 1,000-2,000 IU daily 2
• Encourage vitamin D-rich foods (fatty fish, fortified dairy products) and safe sun exposure (15-30 minutes of midday sun several times weekly) 2
• Recheck 25-hydroxy vitamin D levels after 3 months of supplementation 2
• Low vitamin D may contribute to the patient's reported fatigue symptoms 2

Hypercholesterolemia Management

• For elevated total cholesterol (207 mg/dL) and LDL (144 mg/dL) with low HDL (36 mg/dL), lifestyle modifications should be initiated immediately 3, 4
• Recommend Mediterranean or DASH diet pattern with emphasis on fruits, vegetables, whole grains, lean proteins, and healthy fats 3
• Encourage regular physical activity: minimum 150 minutes of moderate-intensity exercise per week 3
• Consider statin therapy based on calculated 10-year ASCVD risk assessment, particularly with family history of diabetes 3
• HSV infection may potentially exacerbate lipid abnormalities, as herpesvirus infection has been associated with altered cholesterol trafficking in arterial cells 3

Hydration for Elevated Hematocrit (51.1%)

• Increased fluid intake is essential to address the elevated hematocrit of 51.1%, which likely indicates mild dehydration 5
• Recommend minimum of 2-3 liters of water daily 5
• Monitor hematocrit with follow-up laboratory testing in 4-6 weeks 5
• Patient has admitted to poor hydration habits, which directly contributes to this abnormality 5

Mild Hypoglycemia (67 mg/dL)

• For mild hypoglycemia (67 mg/dL), recommend regular, balanced meals with complex carbohydrates 6
• Avoid prolonged fasting; consider small, frequent meals throughout the day 6
• Monitor for symptoms of hypoglycemia (shakiness, dizziness, confusion, sweating) 6
• Given family history of type 2 diabetes, recommend screening for insulin resistance with fasting insulin level and HOMA-IR calculation 6

Mild Metabolic Acidosis (CO2 19 mmol/L)

• Low total CO2 (19 mmol/L) suggests mild metabolic acidosis 6
• Improve hydration status as noted above 6
• Consider checking basic metabolic panel with anion gap and urine studies to determine etiology 6
• This may be related to dehydration and will likely improve with increased fluid intake 6

Elevated Lymphocytes (3.2 x10³/uL)

• Mildly elevated lymphocyte count may reflect the immune response to the current HSV infection 1
• Monitor lymphocyte count with follow-up laboratory testing after HSV treatment 1
• If lymphocytosis persists after resolution of HSV infection, further evaluation may be warranted 1

Follow-up Recommendations

• Schedule follow-up in 2 weeks to assess resolution of HSV lesions 1
• Repeat laboratory testing in 4-6 weeks to monitor improvement in metabolic parameters 5
• Provide counseling regarding safer sex practices and potential for HSV transmission even when asymptomatic 1
• Consider HSV type-specific testing to determine if infection is HSV-1 or HSV-2, which has prognostic implications for recurrence risk 1
• Discuss suppressive therapy options if recurrences become frequent (≥6 per year) 1