A previously healthy 32-year-old man presented with fever, malaise, and odynophagia. Five days before presentation, he awoke with a sore throat and fatigue. During the next several days he developed fever, chills, anorexia, and bloating. He had several episodes of retching but no emesis. Retrosternal pain with swallowing began 2 days after onset of his intial symptoms. The pain quickly became severe, occurred with dry swallows, and limited his oral intake to milk shakes and cottage cheese. He lost 7 pounds. H2 antagonists and liquid antacids did not provide relief of his symptoms. He noted no mouth sores or rash. One week before the onset of his initial symptoms, the patient had begun a sexual relationship with a new female partner that involved orogenital contact. He took no medication, did not smoke, drank only small amounts of alcohol and denied use of illicit drugs. Examination showed him to be moderately uncomfortable, even when swallowing saliva. He was afebrile. There were no oral, genital, or skin lesions. His neck was supple, without adenopathy. The remainder of the examination was normal. Laboratory studies, including a complete blood count and differential, renal and liver function tests were normal. Endoscopy showed many 2 to 3 mm diameter discrete shallow ulcerations with erythematous halos in the midesophagus. The ulcerations became confluent in the distal esophagus. The stomach and duodenum were normal. Histopathologic evaluation of endoscopic biopsies revealed severe acute and chronic inflammation and superficial ulceration (Fig. 1A), as well as intranuclear Cowdry type A inclusion bodies and multinucleated giant cells (Fig. 1B). Culture grew HSV-2. At a later date, serologic studies by Western blot technique showed antibodies to HSV-2 and none to HSV-1. Tests of general immune function included quantitative serum immunoglobulins and standard skin testing, both normal. Human immunodeficiency virus (HIV) 1 and 2 were negative at presentation and again 6 months and 12 months later. Human T cell lymphotrophic virus 1 and 2 were both negative. One year after presentation, his total white blood cell count was 4500 cells/mm3 (normal 4000-11,000) with 25% lymphocytes. CD4 count was 440 cells/mm3 (normal 500-1600) (39%), with a CD4/CD8 ratio of 1.3. The patient was treated with acyclovir, omeprazole, sucralfate, and analgesics and had complete resolution of symptoms within 2 weeks. Two years after the primary infection, there has been no evidence of reactivation.