An 11-year-old girl, who had recently reached menarche, was seen in the pediatric continuity clinic after being evaluated in a community emergency department 1 day earlier for the chief complaint of painful vulvar ulcers. The patient had been referred for a sexual abuse consultation with a child abuse pediatrician because the outside hospital did not have a child protection team. The girl had been in her usual state of health until 5 days before presenting when she developed a sore throat, followed by malaise, decreased oral intake, nausea, and vomiting. Two days later, she noted ulcerlike lesions located on the mucosal surface of her labia minora.

In the emergency department, a rapid strep test and throat culture were obtained. Although the girl denied sexual abuse or sexual contact, given the genital ulcers, she underwent an extensive evaluation for sexually transmitted infections (STIs) and began treatment for presumed genital herpes infection...

You do not currently have access to this content.