A 30-year-old female presents with itchy lesions on her vulva. What condition should you first suspect?

The most appropriate condition to suspect in a 30-year-old female presenting with itchy lesions on the vulva is genital herpes. Genital herpes, caused by the herpes simplex virus (HSV), is characterized by the appearance of painful and itchy vesicular lesions in the genital area. These lesions can be very uncomfortable and often present in clusters.

The itchy and painful nature of the lesions aligns with typical symptoms experienced by individuals with an outbreak of genital herpes. It's also essential to consider that the genital herpes virus remains dormant in the body after the initial infection, which can lead to recurrent outbreaks, often triggered by stress or other factors.

In this case, while other sexually transmitted infections like HIV, gonorrhea, and chlamydia can also be present in sexually active individuals, they typically do not present primarily with itching and vesicular lesions on the vulva. For instance, gonorrhea and chlamydia more commonly present with urinary symptoms or vaginal discharge rather than isolated itchy lesions. HIV is a systemic infection that may lead to more generalized symptoms over time and does not specifically cause localized itchy lesions.