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The most common cause of genital lesions is herpes simplex virus (HSV) (Pediatr Dermatol. 2012;29:147–153). However, in children and adolescents who are not sexually active, several other causes need to be considered.A 13-year-old adolescent girl presented to the emergency department with genital lesions. A gynecologist was consulted at time of presentation for concerns of a primary HSV infection and concurred. Final HSV and sexually transmitted infection testing were subsequently negative. At outpatient follow-up, a child abuse pediatrician made the diagnosis of aphthous genital ulcers (AGUs). Awareness of the diagnosis of AGUs is important because alternate diagnoses such as HSV could imply child abuse. It is critical to include AGUs in the differential diagnosis and to provide the appropriate referrals.