A Young Woman with Genital Ulceration

Abstract

Carol, a 23-year-old woman, attends you, her General Practitioner, with a 3 day history of pain and swelling of the vulva, slightly increased vaginal discharge, and pain on passing urine. When she examined herself using a mirror she noticed that there were many “cuts” all over the genital area. She has difficulty walking on account of the pain. Carol has been generally unwell for a few days and has felt feverish. She has not noticed a skin rash. Previously her general health has been good with no serious illnesses. She is not receiving any medication, and she has not applied ointments or lotions to her genitals. Her most recent menstrual period was 7 days previously and was normal. She has no previous history of genital ulceration. She has been in a regular relationship with Mark for 2 years, and she has had no other sexual contacts in that time. Mark, a 35-year-old man, attends with Carol. He has no symptoms and has no past history of sexually transmitted infections. Both he and Carol had had a sexual health screen shortly after they began their relationship. Neither was identified as having a sexually transmitted infection, although serological testing for previous exposure to herpes simplex virus was not undertaken (see Case 1 ). He tells you that his only sexual partner within the preceding 2 years has been Carol, but previously he has had several heterosexual relationships. They had vaginal and oral sex about 1 week previously. Condoms are used as contraception, but they have used the same brand for several months; they do not use lubricant.