ulceration of vulva

Ulceration of the Vulva: Causes, Symptoms, and Treatment

Ulceration of the vulva refers to the development of open sores or lesions on the external part of the female genitalia [13]. These ulcers can be caused by various factors, including non-sexually transmitted infections, such as bacterial or fungal infections [14].

Causes of Vulvar Ulcers

• Non-infectious causes: aphthosis, inflammatory diseases, blistering diseases, and malignancies [2]
• Infectious causes: herpes simplex, granuloma inguinale (K. granulomatis), lymphogranuloma venereum (C. trachomatis L1-L3), and rare cases of mononucleosis (Epstein-Barr virus) [14]
• Trauma: cuts, chafing, scratches, and other forms of physical irritation or damage to the vulvar tissues [4]

Symptoms of Vulvar Ulcers

• Groups of blisters or red spots on the genitals or buttocks
• A single deep painful ulcer
• Sores that bleed easily on contact
• Flu-like symptoms, including fever [5]
• Large, painful and deep ulcers on the surface of

Common Signs and Symptoms of Vulvar Ulceration

Vulvar ulcers can manifest in various ways, making it essential to be aware of the possible symptoms. According to medical sources [1][2], most vulvar ulcers appear as painful lesions that may leak fluid or bleed. They can also cause substantial swelling or inflammation.

Possible Symptoms:

• Painful lesions on the external layers of the female genitalia and surrounding skin
• Swelling or inflammation in the affected area
• Lesions that may leak fluid or bleed
• Itchiness, fever, discomfort, pain, discharge, or leaky fluid [3]
• Flu-like symptoms, such as cough, sore throat, achiness, or low-grade fever [4]

Other Possible Symptoms:

• Skin changes in the vulva, including rashes, bumps, or warts
• Lesions that may appear as small, red, or flesh-colored bumps and blisters
• Crusty or larger lesions *

Diagnostic Tests for Vulvar Ulceration

Vulvar ulcers can be challenging to diagnose due to their nonspecific clinical morphology. However, various diagnostic tests can aid in identifying the underlying cause of these lesions.

• Physical Examination: A thorough physical examination is essential in evaluating vulvar ulcers. This includes careful history-taking and a detailed examination of the vulva, vagina, and surrounding areas.
• Laboratory Testing: Laboratory testing is often required to confirm the diagnosis of vulvar ulcers. The following tests may be ordered:
  • HSV PCR: Polymerase chain reaction (PCR) testing for herpes simplex virus (HSV-1 and HSV-2) can help diagnose genital herpes.
  • Gram Stain and Culture: A Gram stain and culture can identify bacterial infections, such as syphilis or other bacterial pathogens.
  • VZV PCR: PCR testing for varicella-zoster virus (VZV) can aid in diagnosing genital zoster.
  • Blood Tests: Blood tests may be ordered to rule out systemic infections, such as mononucleosis or EBV-related ulcers.
• Imaging Studies: Imaging studies, such as ultrasound or MRI, may be used to evaluate the extent of vulvar ulceration and rule out other conditions.

Approach to Diagnosis

The approach to diagnosing vulvar ulcers involves a combination of clinical evaluation, laboratory testing, and imaging studies. A dermatologist or infectious disease specialist can aid in determining the cause of these lesions and developing an effective treatment plan.

• Initial Evaluation: The initial evaluation should include a thorough physical examination and laboratory testing for common causes of vulvar ulcers.
• Follow-up Testing: Follow-up testing may be necessary to confirm the diagnosis or rule out other conditions.
• Specialized Testing: Specialized testing, such as PCR or imaging studies, may be ordered based on the results of initial evaluation.

References

[4] Accurately identifying the primary morphology is clinically relevant because most disease states produce either erosions or ulcerations, and correctly identifying the primary lesion can significantly narrow the differential diagnosis. [10] Few reports describe isolation of EBV directly from the base of the ulcer either by culture or by polymerase chain reaction (PCR). [12] Laboratory evaluation of an initial genital ulcer outbreak should include culture or PCR testing for HSV infection, HSV... [14] Swab ulcer(s): Viral: HSV-1 and 2, VZV PCR; Bacterial: Gram stain and culture, syphilis PCR; Fungal: wet prep and culture.

Based on the provided context, it appears that there are various treatments for ulcers on the vulva, depending on their cause.

• For STIs associated with vulvar ulcers, treatment typically involves antibiotics such as doxycycline or azithromycin [8].
• In some cases, surgical removal of the lesion under general anesthesia may be necessary, especially if there are multiple lesions [7].
• For non-infectious causes of vulvar ulcers, such as lichen planus, treatment may involve corticosteroids or other immunosuppressive medications to reduce inflammation and promote healing.
• In addition to medication, comfort measures such as sitz baths, avoidance of irritants, and loose clothing can also help alleviate symptoms [9].

It's worth noting that prompt diagnosis and treatment are essential to prevent transmission between partners and reduce the risk of long-term complications [11]. If you have any specific questions or concerns about vulvar ulcers or their treatment, I'd be happy to try and help.

References: [7] - Surgical removal of lesions [8] - Antibiotic treatment for STIs [9] - Comfort measures for non-infectious causes [11] - Importance of prompt diagnosis and treatment

The differential diagnosis for vulval ulcers is quite extensive, but here are some possible causes:

• Infectious causes: Vulvovaginal candidiasis (yeast infection), herpes simplex virus, syphilis, and chancroid can all cause ulcers on the vulva.
• Non-infectious causes: Trauma, malignancy, Crohn's disease, hidradenitis suppurativa, and other dermatitides can also lead to vulval ulcers.
• Rare conditions: Stevens-Johnson syndrome/toxic epidermal necrolysis, and granulomatous vulvar lesions (such as those caused by non-caseating granulomas) are less common causes of vulval ulcers.

According to [3], the differential diagnosis for vulval ulcers includes:

• Acute vulvar aphthous ulcers
• Trauma
• Malignancy
• Crohn disease
• Hidradenitis suppurativa

Additionally, [4] notes that the differential diagnosis also includes sexually and non-sexually transmitted infections, dermatitides, trauma, neoplasms, hormonally induced ulcers, and drug reactions.

It's worth noting that [9] specifically mentions non-sexually acquired genital ulceration (NSGU) as a cause of painful ulceration on the external genitalia, unrelated to sexual activity.

References:

[3] Margesson LJ. Vulvar Ulcerations: A Review of the Literature. [4] Stewart KMA. Vulvar Ulcers: A Review of the Differential Diagnosis. [9] Non-sexually acquired genital ulceration (NSGU)