Slide 8
A small vulval lesion in a patient with undiagnosed, recurrent HSV-2

This slide shows recurrent herpes in a woman who presented to the genitourinary medicine (GUM) clinic with a 2-year history of recurrent cystitis. She had been extensively investigated with more than 10 sterile urine cultures, sent by both her physician and the hospital accident and emergency department where she had presented. She had also noticed a small area that had caused soreness and discomfort during sexual intercourse, but she had gone to the clinic not thinking that it was related to the cystitis. The small lesion within the vulval fold was positive for HSV-2. A swab taken blindly from the urethra was negative for chlamydia and gonorrhoea but positive for HSV. Suppressive aciclovir therapy prevented the 6- weekly recurrences of ‘cystitis’, as well as the recurrence of external genital lesions.