What test would be most appropriate to confirm a clinical diagnosis of genital vesicular lesions?

The most appropriate test to confirm a clinical diagnosis of genital vesicular lesions is viral culture. This method is particularly effective for diagnosing infections caused by herpes simplex virus (HSV), which is the most common cause of genital vesicular lesions. Viral culture involves collecting fluid from the vesicles or lesions to grow the virus in a laboratory setting. If HSV is present, it will typically grow, providing definitive confirmation of the infection.

While PCR testing is also a highly sensitive and specific method for detecting HSV and has become the preferred test in many clinical settings, it is not the traditional confirmatory test and is typically not as widely used for initial diagnosis in routine practice compared to viral culture.

Serology tests measure the immune response to the virus but cannot confirm active infections, especially useful for determining past infections rather than current lesions. A biopsy would be considered if there is a need to rule out other conditions, such as malignancy, but it is not standard practice for the confirmation of viral infections.

Viral culture remains a gold standard for the diagnosis of active viral infections associated with genital vesicular lesions, making it the most suitable choice for confirming the clinical diagnosis in this context.