Vulvar ulcers are an important clinical presentation in young women. Determination of sexual activity is vital in the diagnostic and management approach of patients. Sexually active patients most often have vulvar ulcers secondary to infection with herpes simplex virus (HSV). While the majority of HSV infections are asymptomatic, both HSV-1 and HSV-2 can cause symptomatic genital herpes with HSV-1 causing less frequent recurrences. Primary genital HSV infection has a recognizable clinical picture, and patients should be tested with HSV PCR assay as well as for other possible sexually transmitted infections and treated with antivirals. Recurrent genital HSV infection not previously recognized should establish the diagnosis with PCR assay both for anticipatory guidance and management. Suppressive therapy is an important management strategy to minimize patient recurrences and decrease transmission likelihood.
KeywordsHerpes simplex virus (HSV) Sexually transmitted infection Vulvar ulceration
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Suggested Educational Reading, References, and Policies
- Centers for Disease Control and Prevention. Sexually Transmitted Diseases Treatment Guidelines. MMWR Recomm Rep. 2015;64(RR-3):1–137.Google Scholar