Atypical Genital Herpes Presenting as Chronic Severe Vulvitis: A Case Report

Genital herpes is a common sexually transmitted infection, yet its clinical presentation can be highly variable, particularly in immunocompetent individuals. Atypical manifestations often lead to misdiagnosis and delayed treatment. We report a case of a 59‑year‑old female who presented with a six‑month history of vulvar erythema, exudation, increased discharge, pruritus, and pain. She had been repeatedly diagnosed with vulvitis and contact dermatitis, receiving multiple courses of antibiotics, corticosteroids, and antihistamines without sustained improvement. Two vulvar biopsies revealed non‑specific dermatitis with eosinophilic infiltration, and extensive microbiological workup was negative for common pathogens. After hospitalization, localized saline cleansing helped reveal pinpoint erosions on the labia, prompting HSV‑2 DNA testing by polymerase chain reaction (PCR), which confirmed the diagnosis. Serological testing suggested a previous HSV‑2 exposure rather than a primary infection. The patient was treated with valacyclovir, resulting in complete resolution within eight days. This case underscores the importance of considering HSV infection in patients with chronic or recurrent vulvitis, especially when conventional treatments fail. In this instance, saline cleansing served as a simple bedside observation to unmask subtle lesions, though it should not be regarded as a validated diagnostic maneuver without further evidence. Early recognition and targeted antiviral therapy remain essential to prevent prolonged morbidity.