CONCURRENT CLINICALLY DIAGNOSED GENITAL HERPES, SECONDARY SYPHILIS, AND VULVOVAGINAL CANDIDIASIS IN EARLY PREGNANCY: A CASE REPORT

Abstract

Sexually transmitted infections (STIs) are highly prevalent worldwide among individuals of reproductive age and pose substantial risks in pregnancy, including adverse maternal and neonatal outcomes. Genital herpes, syphilis, and vulvovaginal candidiasis may occur concurrently during pregnancy and present with overlapping genital manifestations, but reports describing their concurrent occurrence in early pregnancy remain limited. A 22-year old woman at 12 weeks’ gestation presented with painful genital ulcers preceded by vesicles, pruritus, burning sensation, dysuria, and fever for the past five days. The patient also reported odorless, milky vaginal discharge. The patient reported her first unprotected sexual intercourse 5 months prior with her husband. The patient denied multiple sexual partners, whereas her husband reported multiple sexual partners. Her husband had a history of minimally painful genital lesions, with laboratory findings reactive for IgM anti-HSV I/II, VDRL and TPHA. Venereological examination of the vulvar showed multiple erosive–ulcerative lesions. Genital herpes was clinically suspected; however, direct HSV testing, including PCR/NAAT, viral culture, lesion swab testing, or type-specific HSV-1/HSV-2 serology, was not performed, and therefore HSV infection could not be laboratory confirmed or definitively classified as primary. At follow-up, the genital lesions had improved, but erythematous scaly macules and patches developed on the palms and soles. TPHA was reactive and VDRL was reactive with a titer of 1:32, while rapid HIV testing was non-reactive, supporting a diagnosis of secondary syphilis. Vaginal microscopy showed yeast cells and hyphae/pseudohyphae without clue cells, supporting vulvovaginal candidiasis. Long-term maternal and neonatal outcomes could not be reported because the pregnancy and follow-up were still ongoing at the time of manuscript preparation. The patient received benzathine penicillin G 2.4 million IU intramuscularly as a single dose and nystatin 100,000 IU intravaginally for five days. The candidiasis-related symptoms improved after treatment, and follow-up VDRL testing on 13 May 2026 showed a decline in titer to 1:8. This case highlights the importance of comprehensive evaluation in pregnant women presenting with genital lesions and vaginal symptoms, as multiple genital infections may occur concurrently. Genital herpes may be diagnosed clinically based on characteristic lesions, while laboratory testing supports the diagnosis of concomitant infections. Treatment should be individualized according to pregnancy status and current clinical guidelines.