A patient with clear vesicular lesions and tender bilateral adenopathy likely has which condition?

The presentation of clear vesicular lesions along with tender bilateral adenopathy is highly indicative of genital herpes. Herpes simplex virus (HSV) infections commonly manifest with vesicular lesions, which are typically painful and can appear on various genital surfaces. These vesicles eventually ulcerate, leading to painful lesions, and often, patients experience additional symptoms such as fever and malaise during the initial outbreak.

The tender bilateral adenopathy is also suggestive of a viral infection, as lymphadenopathy often occurs in response to the viral load and the immune response to the infection. In the case of genital herpes, the lymph nodes in the groin (inguinal lymph nodes) are frequently involved, becoming tender and enlarged.

Dysuria, while it can occur with various infections, does not specifically correlate with the vesicular lesions. Gonorrhea typically presents with purulent discharge and symptomatic cystitis rather than vesicular lesions. Syphilis, particularly in its primary stage, presents with a painless ulcer (chancre) rather than vesicular lesions, and while there can be adenopathy, it does not usually result in the clear vesicular lesions characteristic of herpes.

Thus, the combination of clear vesicular lesions and tender bilateral adenopathy strongly supports a diagnosis of genital herpes