title: An atypical herpetic vulval ulcer in an African woman: an important lesson.
abstract: A 43-year-old woman from Southern Africa presented with an eight-month history of a painless vulval ulcer. She did not have any relevant past medical or drug history. She had never had, or ever been offered an HIV antibody test despite being from an endemic region. On examination, there was an ulcer on her right labia and a painless right inguinal lymph node. Herpes simplex virus (HSV) type 2 culture was positive. The HIV antibody test was also positive. Other cultures and serology including syphilis were negative. A biopsy was suggestive of herpes simplex. The vulval ulcer resolved on oral aciclovir only. Atypical genital herpes has been described in HIV disease, although it is often painful. This case emphasises the importance of offering an HIV antibody test to patients presenting with atypical genital ulcers. Moreover, it reinforces the paradigm that 'any anogenital ulcer (painful or not) can be herpetic in origin'.
authors.affiliation: St Mary's Hospital, London W2 1NY, UK.
authors.forename: Ioulios
authors.initials: I
authors.lastname: Palamaras
authors.forename: Daniel
authors.initials: D
authors.lastname: Richardson
authors.forename: Vourneen
authors.initials: V
authors.lastname: Healy
authors.forename: Deirdre
authors.initials: D
authors.lastname: Lyons
authors.forename: Micheline
authors.initials: M
authors.lastname: Byrne
authors.forename: Harpal
authors.initials: H
authors.lastname: Lamba
mesh_terms: D000328:Adult; D005260:Female; D005831:Genital Diseases, Female / Q000821:virology; D015483:HIV Antibodies / Q000097:blood; D015658:HIV Infections / Q000150:complications*; D015497:HIV-1; D006558:Herpes Genitalis / Q000150:complications* / Q000821:virology; D018258:Herpesvirus 2, Human / Q000302:isolation & purification*; D006801:Humans; D013019:South Africa; D014844:Vulva / Q000821:virology*; D014845:Vulvar Diseases / Q000821:virology*
chemical_list: D015483:HIV Antibodies