Review Question - QID 108677

A 25-year-old G1P0 woman presents for her 1st obstetric visit at 13 weeks gestation. Aside from mild nausea, she has had occasional nonbloody diarrhea over the last 3 weeks. She has not experienced pelvic pain or vaginal bleeding. She has a past medical history of asthma and Crohn disease for which she is on infliximab. Since starting infliximab, the patient has noted several cold sores on her mouth and once had a similar lesion on her vulva, but it resolved without treatment. She is allergic to ampicillin and experiences anaphylaxis with this agent. The patient is a waitress and is sexually active with her husband of 5 years. At this visit, her temperature is 98.9°F (37.2°C), blood pressure is 119/78 mmHg, pulse is 71/min, and respirations are 14/min. On exam, there is a 2-cm ulcerated lesion on the vaginal mucosa, as shown in Figure A. There is no pain when the lesion is palpated. There is also bilateral inguinal lymphadenopathy without tenderness. Which of the following is the most appropriate next step in management?