Case Report
Genital ulcers caused by Epstein-Barr virus

https://doi.org/10.1016/j.jaad.2004.04.028Get rights and content

Abstract

In North America, the most common cause of vulvar ulcers is infection with herpes simplex virus. However, Epstein-Barr virus can also cause vulvar ulcers, and may be underrecognized. Unlike herpes simplex virus, Epstein-Barr virus is not necessarily sexually transmitted. Therefore, it is particularly important to include in the differential diagnosis of genital ulcers for patients for whom a diagnosis of a venereal infection has important psychosocial consequences. We report three cases of acute primary Epstein-Barr virus infection in which the presenting symptoms were vulvar ulceration.

Section snippets

Case 1

A 19-year-old woman presented to the emergency department with a 1-week history of painful vulvar ulcers, dysuria, and fever. She had engaged in sexual contact with a new partner 6 weeks earlier. Oral acyclovir was empirically started. However, a herpes simplex virus (HSV) culture was negative. The ulcers persisted and increased in number. Three days later she was referred to the gynecology department. Again, an HSV culture was negative. The patient was then referred to the dermatology

Discussion

Determining the cause of vulvar ulcers can be challenging. The clinical presentation and pattern of recurrences must be considered along with such factors as age, demographics, travel, sexual history (including abuse), and immune status. Worldwide, syphilis, chancroid, lymphogranuloma venerum, and granuloma inguinale are the most common causes of vulvar ulcers.2 In North America, the most common cause, by far, is HSV (Table I).

Because the differential diagnosis is extensive, the evaluation of

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    Infectious causes like HSV, Syphilis, lymphogranuloma venereum, chancroid and HIV should be considered in young patients who are sexually active, being HSV etiology the most common and potentially also non sexually-transmitted. HSV-PCR assay is thus the first step in the management of vulvar ulcers [[4,5] JEADV 2004, Mayo 2010]. Instead, when a documented sexually transmitted infectious etiology lacks or in the presence of a virgin female, other infective agents are to be considered besides inflammatory, autoimmune, traumatic and neoplastic causes [6].

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Funding sources: None.

Conflicts of interest: None identified.

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