Case of a Girl with Vulvar Ulcers

  • Marina Catallozzi
  • Susan L. Rosenthal
  • Lawrence R. Stanberry
Chapter

Abstract

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.

Keywords

Herpes simplex virus (HSV) Sexually transmitted infection Vulvar ulceration 

References

  1. 1.
    Lewis FM, Velangi SS. An overview of vulvar ulceration. Clin Obstet Gynecol. 2005;48(4):824–37.CrossRefPubMedGoogle Scholar
  2. 2.
    Rosman IS, Berk DR, Bayliss SJ, et al. Acute genital ulcers in nonsexually active young girls: case series, review of the literature, and evaluation and management recommendations. Pediatr Derm. 2012;29(2):147–53.CrossRefGoogle Scholar
  3. 3.
    Centers for Disease Control and Prevention. Sexually transmitted diseases treatment guidelines. MMWR Recomm Rep. 2015;64(RR-3):1–137.Google Scholar
  4. 4.
    Satterwhite CL, Torrone E, Meites E, et al. Sexually transmitted infections among US women and men: prevalence and incidence estimates, 2008. Sex Transm Dis. 2013;40(3):187–93.CrossRefPubMedGoogle Scholar
  5. 5.
    Fanfair RN, Zaidi A, Taylor LD, et al. Trends in seroprevalence of herpes simplex virus type 2 among non-hispanic blacks and non-hispanic whites aged 14 to 49 years—United States, 1988 to 2010. Sex Transm Dis. 2014;40(100):860–4.Google Scholar
  6. 6.
    Bradley H, Markowitz LE, Gibson T, et al. Seroprevalence of herpes simplex virus types 1 and 2—United States, 1999-2010. J Infect Dis. 2014;209:325–33.CrossRefPubMedGoogle Scholar
  7. 7.
    Stanberry LR. Genital and perinatal HSV infections. In: Stanberry LR, Rosenthal SL, editors. Sexually transmitted diseases: vaccines, prevention and control. 2nd ed. New York: Elsevier; 2013. p. 273–313.CrossRefGoogle Scholar
  8. 8.
    Gnann JW, Whitley RJ. Genital herpes. NEJM. 2016;375:666–74.CrossRefPubMedGoogle Scholar
  9. 9.
    Bernstein DI, Bellamy AR, Hook EW. Epidemiology, clinical presentation, and antibody response to primary infection with herpes simplex virus type 1 and type 2 in young women. Clin Infect Dis. 2013;56(3):344–51.CrossRefPubMedGoogle Scholar
  10. 10.
    Whitley RJ, Kimberlin DW, Roizman B. Herpes simplex viruses. Clin Infect Dis. 1998;26:541–55.CrossRefPubMedGoogle Scholar
  11. 11.
    Wald A, Langenberg AG, Link K, et al. Effect of condoms on reducing the transmission of herpes simplex virus type 2 from men to women. J Am Med Assoc. 2001;284(24):3100–6.CrossRefGoogle Scholar
  12. 12.
    Wald A, Langenberg AG, Krantz E, et al. The relationship between condom use and herpes simplex virus acquisition. Ann Intern Med. 2005;143(10):707–13.CrossRefPubMedGoogle Scholar
  13. 13.
    Sehgal VN, Pandhi D, Khurana A. Nonspecific genital ulcers. Clin Dermatol. 2014;32:259–74.CrossRefPubMedGoogle Scholar
  14. 14.
    LeGoff J, Pete H, Belec L. Diagnosis of genital herpes simplex virus infection in the clinical library. Virology. 2014;11:83.CrossRefGoogle Scholar
  15. 15.
    US Preventive Services Task Force Recommendation Statement. Serologic screening for genital herpes infection. JAMA. 2016;316(23):2525–30.CrossRefGoogle Scholar
  16. 16.
    US Preventive Services Task Force Evidence Report. Serologic screening for genital herpes. JAMA. 2016;316(23):2531–43.CrossRefGoogle Scholar
  17. 17.
    Hook EW. A recommendation against serologic screening for genital herpes infection—what now? JAMA. 2016;316(23):2493–4. http://www.ashasexualhealth.org/stdsstis/herpes/
  18. 18.
    Martin ET, Krantz E, Gottlieb SL, et al. A pooled analysis of the effect of condoms in preventing HSV-2 acquisition. Arch Intern Med. 2009;169(13):1233–40.CrossRefPubMedPubMedCentralGoogle Scholar

Suggested Educational Reading, References, and Policies

  1. Centers for Disease Control and Prevention. Sexually Transmitted Diseases Treatment Guidelines. MMWR Recomm Rep. 2015;64(RR-3):1–137.Google Scholar
  2. Gnann JW, Whitley RJ. Genital herpes. N Engl J Med. 2016;375:666–74.CrossRefPubMedGoogle Scholar
  3. US Preventive Services Task Force Evidence Report. Serologic screening for genital herpes. JAMA. 2016;316(23):2531–43.CrossRefGoogle Scholar
  4. US Preventive Services Task Force Recommendation Statement. Serologic screening for genital herpes infection. JAMA. 2016;316(23):2525–30.CrossRefGoogle Scholar

Copyright information

© Springer International Publishing AG 2018

Authors and Affiliations

  • Marina Catallozzi
    • 1
  • Susan L. Rosenthal
    • 2
  • Lawrence R. Stanberry
    • 3
  1. 1.Division of Child and Adolescent Health, Department of Pediatrics, Heilbrunn Department of Population and Family HealthColumbia University Medical Center, Morgan Stanley Children’s Hospital at New York PresbyterianNew YorkUSA
  2. 2.Division of Child and Adolescent Health, Department of PediatricsColumbia University Medical Center, Morgan Stanley Children’s Hospital at New York PresbyterianNew YorkUSA
  3. 3.Department of PediatricsColumbia University Medical Center, Morgan Stanley Children’s Hospital at New York PresbyterianNew YorkUSA

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