Slide 14
Impetigo initially misdiagnosed as genital herpes*

This woman presented to her physician complaining of vulval soreness. A visual examination resulted in the physician conveying to her a diagnosis of genital HSV infection. No swabs were taken but because she was so distressed she was referred to a specialist gynaecologist. The gynaecologist examined her, took no further swabs and prescribed aciclovir cream for her presumed genital herpes. Still distressed, she was concerned that she had acquired the infection from her husband who had previously travelled extensively. She eventually attended the local genitourinary medicine service having used aciclovir cream at the appropriate times. The lesions had not improved and the associated eczema on her hands suggested that she might have a dermatological cause for her symptoms and signs. Indeed, a full screen for STIs was negative and tests for HSV likewise. The vulval bacteriology sample revealed copious Staphylococcus aureus organisms and her lesions responded appropriately to treatment with antibiotics. It is probable that this patient had secondary infected eczema causing impetigo. It is essential that physicians who are making a diagnosis of genital herpes take appropriate tests to confirm and type the infectious cause, as well as to exclude alternative diagnoses. Without doing so the potential impact on the patient’s relationship could have been catastrophic.
* Reproduced by kind permission from: Leibowitch M, Staughton R, Neill S, Barton S, Marwood R. An Atlas of Vulval Disease. 1994. Martin Dunitz, London
www.dunitz.co.uk