Current Infectious Disease Reports

, Volume 11, Issue 6, pp 449–456

Genitourinary manifestations of Epstein-Barr virus infections

Article

Abstract

Epstein-Barr virus (EBV) is best known as the organism responsible for the syndrome of acute infectious mononucleosis. Transmission of EBV most commonly occurs through oral secretions. EBV has also been isolated from the female genital tract, where its role is poorly understood. This article reviews the available literature and data regarding EBV in the female genital tract and discusses areas of consensus and controversy. The primary manifestation of EBV seems to be vulvar ulcers, which are underrecognized. Diagnosis relies on appropriate serologic testing. Management includes local care and may require pain and corticosteroid medications. Although EBV is present elsewhere in the female genital tract, its pathogenic role in the cervix, uterus, fallopian tubes, and ovaries is poorly understood.

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References and Recommended Reading

  1. 1.
    Cheng SX, Chapman MS, Margesson LJ, et al.: Genital ulcers caused by Epstein-Barr virus. J Am Acad Dermatol 2004, 51:824–826.CrossRefPubMedGoogle Scholar
  2. 2.
    Jenson HB: Acute complications of Epstein-Barr virus infectious mononucleosis. Curr Opin Pediatr 2000, 12:263–268.CrossRefPubMedGoogle Scholar
  3. 3.
    Auwaerter PG: Infectious mononucleosis in middle age. JAMA 1999, 281:454–459.CrossRefPubMedGoogle Scholar
  4. 4.
    Barnes CJ, Alió AB, Cunningham BB, Friedlander SF: Epstein-Barr virus-associated genital ulcers: an under-recognized disorder. Pediatr Dermatol 2007, 24:130–134.CrossRefPubMedGoogle Scholar
  5. 5.
    Ikediobi NI, Tyring SK: Cutaneous manifestations of Epstein-Barr virus infection. Dermatol Clin 2002, 20:283–289.CrossRefPubMedGoogle Scholar
  6. 6.
    Hollier LM, Grissom H: Human herpes viruses in pregnancy: cytomegalovirus, Epstein-Barr virus, and varicella zoster virus. Clin Perinatol 2005, 32:671–696.CrossRefPubMedGoogle Scholar
  7. 7.
    Katz BZ, Miller G: Epstein-Barr virus infections. In Krugman’s Infectious Diseases of Children, edn 11. Edited by Gershon AA, Hotez PJ, Katz SL. Philadelphia: Elsevier; 2004. Available at http://www.MDconsult.com. Accessed June 2009.Google Scholar
  8. 8.
    Naher H, Gissmann L, Freese UK, et al.: Subclinical Epstein-Barr virus infection of both the male and female genital tract-indication for sexual transmission. J Invest Dermatol 1992, 98:791–793.CrossRefPubMedGoogle Scholar
  9. 9.
    Taylor Y, Melvin WT, Sewell HF, et al.: Prevalence of Epstein-Barr virus in the cervix. J Clin Pathol 1994, 47:92–93.CrossRefPubMedGoogle Scholar
  10. 10.
    Portnoy J, Ahronheim GA, Ghibu F, et al.: Recovery of Epstein-Barr virus from Genital Ulcers. N Engl J Med 1984, 966–967.Google Scholar
  11. 11.
    Halvorsen JA, Brevig T, Aas T, et al.: Genital ulcers as initial manifestation of Epstein-Barr virus infection: two new cases and a review of the literature. Acta Derm-Venereol 2006, 86:439–442.CrossRefPubMedGoogle Scholar
  12. 12.
    Pelletier F, Leblanc L, Estavoyer JM, et al.: Ulcere de Lipshutz au cours d’une primo-infection a virus Epstein-Barr [in French]. Ann Dermatol Venereol 2002, 129:904–907.Google Scholar
  13. 13.
    Taylor S, Drake SM, Dedicoat M, Wood MJ: Genital ulcers associated with acute Epstein-Barr virus infection. Sex Transm Infect 1998, 74:296–297.CrossRefPubMedGoogle Scholar
  14. 14.
    Farhi D, Wendling J, Molinari E, et al.: Non-sexually related acute genital ulcers in 13 pubertal girls. Arch Dermatol 2009, 145:38–45.CrossRefPubMedGoogle Scholar
  15. 15.
    Svedman C, Holst R, Johnsson A: Ulcus vulvae acutum, a rare diagnosis to keep in mind. Eur J Obstet Gynecol Reprod Biol 2003, 115:104–105.CrossRefGoogle Scholar
  16. 16.
    van Baarle D, Hovencamp E, Dukers NH, et al.: High prevalence of Epstein-Barr virus type 2 among homosexual men is caused by sexual transmission. J Infect Dis 2000, 181:2045–2049.CrossRefPubMedGoogle Scholar
  17. 17.
    Pagano JS: Is Epstein-Barr virus transmitted sexually? J Infect Dis 2007, 195:469–470.CrossRefPubMedGoogle Scholar
  18. 18.
    Llanos AN, Climent VD, Eguinoa JE, Lllave EP: Epstein-Barr virus primary infection: a poorly known cause of acute genital ulcers [in Spanish]. Revista Clinica Espanola 1996, 196:570–571.Google Scholar
  19. 19.
    Huppert JS, Gerber MA, Deitch HR, et al.: Vulvar ulcers in young females: a manifestation of aphthosis. J Pediatr Adolesc Gynecol 2006, 19:195–204.CrossRefPubMedGoogle Scholar
  20. 20.
    Hernandez-Nunez A, Cordoba S, Romero-Mate A, et al.: Lipchutz ulcers—four cases. Pediatric Dermatology 2008, 25:364–367.CrossRefPubMedGoogle Scholar
  21. 21.
    Deitch HR, Huppert J, Hillard PJA: Unusual Vulvar Ulcerations in Young Adolescent Females. J Pediatr Adolesc Gynecol 2004, 17:13–16.CrossRefPubMedGoogle Scholar
  22. 22.
    Pardo A, Figueroa JP: Acute vulvar ulcer or Lipschutz disease [in Spanish]. Revista Chilena de Obstetricia Gynecologico y Ginecologica 1966, 31:219–221.Google Scholar
  23. 23.
    Brown ZA, Stenchever MA: Genital ulceration and infectious mononucleosis: a report of a case. Am J Obstet Gynecol 1977, 127:673–674.PubMedGoogle Scholar
  24. 24.
    Tattevin P, Tulzo YL, Minjolle S, et al.: Increasing incidence of severe Epstein-Barr virus-related infectious mononucleosis: surveillance study. J Clin Microbiol 2006, 44:1873–1874.CrossRefPubMedGoogle Scholar
  25. 25.
    Morris MC, Edmunds EJ: The changing epidemiology of infectious mononucleosis? J Infect 2002, 45:107–108.CrossRefPubMedGoogle Scholar
  26. 26.
    Hudson LB, Perlman SE: Necrotizing genital ulcerations in a premenarcheal female with mononucleosis. Obstet Gynecol 1998, 92:642–644.CrossRefPubMedGoogle Scholar
  27. 27.
    Johnson TR, Landry MS: College blues and hues. Obstet Gynecol 2007, 109:1447–1448, 1461–1462.PubMedGoogle Scholar
  28. 28.
    Logeart I, Blondon H, Caulin C: Acute ulceration of the vulva during a primary Epstein-Barr virus infection [in French]. Presse Medicale 1998, 27:571–572.Google Scholar
  29. 29.
    Young RH, Harris NL, Scully RE: Lymphoma-like lesions of the lower female genital tract: a report of 16 cases. Int J Gynecol Pathol 1985, 4:289–299.PubMedCrossRefGoogle Scholar
  30. 30.
    Nicolas X, Ansart S, Jaffuel S, et al.: Genital ulcerations due to Epstein-Barr virus primary infection [in French]. Revue de Medecine Interne 2005, 26:913–916.CrossRefPubMedGoogle Scholar
  31. 31.
    Anderrson-Ellstrom A, Bergstrom T, Svennerholm B, Milsom I: Epstein-Barr virus DNA in the uterine cervix of teenage girls. Obstet Gynecol Scand 1997, 76:779–783.CrossRefGoogle Scholar
  32. 32.
    Lampert A, Assier-Bonnet H, Chevallier B, et al.: Lipschutz’s genital ulceration: a manifestation of Epstein-Barr virus primary infection. Br J Dermatol 1996, 135:663–665.CrossRefPubMedGoogle Scholar
  33. 33.
    Groulier JL, Pellegrin JL, Marchal C et al.: Genital ulceration in infectious mononucleosis [in French]. Presse Medicale 1986, 15:2167.Google Scholar
  34. 34.
    Lorenzo CV, Robertson WS: Genital ulcerations as presenting symptom of infectious mononucleosis. J Am Board Fam Pract 2005, 18:67–68.CrossRefPubMedGoogle Scholar
  35. 35.
    Kantakamalakul W, Kanyok R, Naksawat P, Puthavathana P: Prevalence of type specific Epstein-Barr virus in the genital tract of genital herpes suspected patients. J Med Assoc Thai 1999, 82:263–267.PubMedGoogle Scholar
  36. 36.
    Tenorio V, Parra C, Uriz S, et al.: Febre I ulcers genitals en una nena de 2 anys [in Catalan/Spanish]. Pediatria Catalana 2004, 64:88–89.Google Scholar
  37. 37.
    McKenna G, Edwards S, Cleland H: Genital ulceration secondary to Epstein Barr virus infection. Genitourin Med 1994, 70:356–357.PubMedGoogle Scholar
  38. 38.
    Candy B, Hotopf M: Steroids for symptom control in infectious mononucleosis. Cochrane Database Syst Rev 2006, 3:CD004402.PubMedGoogle Scholar
  39. 39.
    Santos NBM, Villanova FE, Andrade PM, et al.: Epstein-Barr virus detection in invasive and pre-invasive lesions of the uterine cervix. Oncol Rep 2008, 21:403–405.Google Scholar
  40. 40.
    Gradlione A, Vercillo R, Napolitano M, et al.: Prevalence of human papillomavirus, cytomegalovirus, and Epstein-Barr virus in the cervix of healthy women. J Med Virol 1996, 50:1–4.CrossRefGoogle Scholar
  41. 41.
    Voog E, Ricksten A, Stenglein M, et al.: Are acetowhite lesions of the cervix correlated to the presence of Epstein-Barr virus DNA? Int J STD AIDS 1997, 8:432–436.CrossRefPubMedGoogle Scholar
  42. 42.
    Thoe SYS, Wong KK, Pathmanathan R, et al.: Elevated secretory IgA antibodies to Epstein-Barr virus (EBV) and presence of EBV DNA and EBV receptors in patients with cervical carcinoma. Gynecol Oncol 1992, 50:168–172.CrossRefGoogle Scholar
  43. 43.
    Lattario F, Furtado YL, Silveira FA, et al.: Evaluation of DAPK gene methylation and HPV and EBV infection in cervical cells from patients with normal cytology and colposcopy. Arch Gynecol Obstet 2008, 277:505–509.CrossRefPubMedGoogle Scholar
  44. 44.
    Melegh Z, Sutak J, Whiteway A, et al.: Lymphomatoid granulomatosis of the uterine cervix. Pathol Res Pract 2009, 305:371–374.CrossRefGoogle Scholar
  45. 45.
    Goker BO, Bese T, Ilvan S, et al.: A case with multiple gynecological malignancies. Int J Gynecol Cancer 2005, 15:372–376.CrossRefPubMedGoogle Scholar
  46. 46.
    Magliore LK, Pettker CM, Buhimschi CS, Funai EF: Burkitt’s lymphoma of the ovary in pregnancy. Obstet Gynecol 2006, 108:743–745.Google Scholar
  47. 47.
    Littman AJ, Rossing MA, Madeleine MM, et al.: Association between late age at infectious mononucleosis, Epstein-Barr virus antibodies, and ovarian cancer risk. Scand J Infect Dis 2003, 35:728–735.CrossRefPubMedGoogle Scholar
  48. 48.
    Sisson BA, Glick L: Genital ulceration as a presenting manifestation of infectious mononucleosis. J Pediatr Adolesc Gynecol 1998, 11:185–187.PubMedGoogle Scholar
  49. 49.
    DeKlotz CMC, Frieden IJ: Picture of the month quiz case. Vulvar ulcerations resulting from acute Epstein-Barr virus infection. Arch Pediatr Adolesc Med 2008, 162:86–87.CrossRefPubMedGoogle Scholar
  50. 50.
    Taylor SN, Martin DH, Leone P, et al.: Chancroid, genital herpes, lymphogranuloma venereum and syphilis. In Current Diagnosis and Treatment of Sexually Transmitted Diseases. Edited by Klausner JD, Hook EW. New York: McGraw-Hill; 2007:69–75, 84–92, 108–116, 119–142.Google Scholar

Copyright information

© Current Medicine Group, LLC 2009

Authors and Affiliations

  1. 1.Department of Obstetrics and GynecologyDrexel University College of MedicinePhiladelphiaUSA

Personalised recommendations