An adolescent girl suffering from primary herpes genitalis

A report describes the case of an 18-year-old, unmarried adolescent who presented with complaints of intense itching sensation in the vulval region for the past five days. She also had mild constitutional symptoms. Examination revealed multiple well-defined grouped erosions over both labia majora extending slightly onto perineal skin. Erosions were associated with intense erythema, and there was significant edema of the whole external genitalia. The lesions caused severe pain that made sitting and walking difficult. The patient documented a history of pre-marital sexual contact with two partners during the past month, with unprotected sex five days before the onset of genital lesions. She also documented similar complaints in her partners. She came negative for HIV, HBS antigen, HCV, STS (serologic test for syphilis), toxoplasma serology, CMV, and Rubella. Her Herpes simplex serology showed positivity for IgG but negativity for IgM. She was diagnosed with herpes simplex type-2 and received valacyclovir 1000 mg twice a day for seven days and azithromycin 500 mg once a day for five days to decrease secondary infection. She also received Lignocaine jelly, sitz bath, and colloidal silver (antiseptic) ointment application as supportive treatment. For local pain, she also received analgesics. 

After four to six weeks, her symptoms improved, and the lesion diminished, leaving only small discrete white papules visible. During follow-up, she received information about the risk of recurrence and potential obstetric complications in the future. Counseling included discussions about the dangers of engaging in unprotected pre-marital sex and the possibility of lesion recurrence.

Goel N, Vardhan S, Goel S, et al. Primary herpes genitalis in an adolescent girl – a nightmare. Indian obstetrics and gynecology. 2023;13(4)