Background/introduction Herpes Simplex 1 virus has historically been known to cause oral and genital symptoms, whereas Herpes Simplex 2 virus is mostly associated with genital symptoms. We present the first case in the UK, to our knowledge, of primary Herpes Simplex 2 virus causing genital and pharyngo-tonsillar ulceration in a sexually active female patient.

Case A 33 year old female patient attended the GUM clinic reporting 2 day history of genital sores associated with dysuria. She has recently completed a 3 day course of Nitrofurantoin for presumed UTI with no effect, and is currently taking a course of Penicillin for tonsillitis. She has a new male partner of 1 month duration. Genital examination revealed bilateral inguinal lymphadenopathy with multiple herpetic lesions on the labia majora and minora. Pharyngeal examination revealed pustular looking tonsils with ulceration bilaterally, more marked on the left. Cervical chain lymphadenopathy was also present. HSV PCR swabs taken from both the tonsillar and genital ulcers came back positive for HSV-2. She was initially treated with a 10 day course of Aciclovir and returned for follow up 1 week later. Repeat examination revealed fully healed vulval ulcers and normal tonsillar appearance.

Discussion/conclusion This is the first UK reported case of primary HSV-2 causing pharyngo-tonsillar ulceration in addition to genital symptoms. The patient made a full and rapid recovery following prompt treatment with Aciclovir. This case highlights the importance of recognising less common causes for tonsillitis such as HSV-2, which responds very quickly to antiviral treatment.