A cluster of vesicles or pustules on an erythematous base is suggestive of herpes. Clinical manifestations of genital herpes infection vary widely, and it can be difficult to distinguish between primary, non-primary and recurrent episodes due to overlapping presentations. In general, primary episodes have more systemic symptoms and lesions will be at different stages of healingFootnote 20. Recurrent episodes are typically unilateral whereas primary episodes are frequently bilateralFootnote 20.