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A 23-year-old woman presents with painful vulval ulcers and severe dysuria (Figure). She has not been sexually active for the past three months and is otherwise well. She has no history of gastrointestinal disease.
On examination, several superficial ulcers are visible that have a red areola and a sloughy yellow-green base measuring 3 to 5 mm. The lesions are located mainly on the labia minora, which are oedematous. She does not have any oral ulceration.
The patient reports similar episodes over the past few years that have resolved spontaneously. On this occasion, however, the ulcers are so painful that she is not able to urinate and she requires admission to hospital for catheterisation.