Viral Illness, Not STD, May Be Cause of Vulvar Ulcers


ATLANTA — Vulvar ulcers were associated with a viral illness rather than a sexually transmitted disease in 14 of 46 patients under age 22, based on the findings of a retrospective study.

“Many practitioners are quick to diagnose a genital ulcer as a sexually transmitted disease because STDs are the most common cause; but young women can present with vulvar ulcers that are secondary to a viral infection,” Dr. Rebecca Kyle said in a poster presented at the annual meeting of the North American Society for Pediatric and Adolescent Gynecology.

“Although such cases may be rare, misdiagnosing this as an STD can be devastating to the patient and her family and can lead to the prescription of unnecessary medications,” she noted.

The findings confirm the need for a thorough physical and history for all young women who present with vulvar or labial ulcers, said Dr. Kyle.

Dr. Kyle and her colleagues at the University of Missouri-Kansas City conducted a retrospective study of all patients aged 12–21 years who presented to Children's Mercy Hospital between 1999 and 2005 with a diagnosis of vulvar ulcer or lesion.

Of the 46 charts identified, “31 were excluded for diagnoses inconsistent with vulvar ulcer or for having positive lab results consistent with a sexually transmitted disease,” said Dr. Kyle.

Of the remaining 15 patients, 14 reported an antecedent history of viral symptoms. “One of the 14 patients with a viral history was eventually diagnosed with Crohn's disease and another patient, who experienced recurrent ulcers, was referred to rheumatology for suspicion of Behçet's disease,” she said.

All of the patients with non-sexually transmitted ulcers were treated symptomatically with complete resolution of the presenting ulcer, said Dr. Kyle.

Additionally, “although they are diagnoses of exclusion, Crohn's disease and Behçet's syndrome must be considered in patients with non-sexually transmitted genital ulcers, particularly when the ulcers are recurrent and occur in conjunction with or following other viral symptoms,” Dr. Kyle stressed.

In particular, she noted, vulvar ulcers that occur in combination with oral ulcers and eye complaints should raise suspicion of Behçet's and those that occur in association with gastrointestinal symptoms potentially point to Crohn's, although genital ulcers as an extraintestinal manifestation of Crohn's can precede intestinal symptoms as well.

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