Acute Genital Ulcers in Nonsexually Active Young Girls: Case Series, Review of the Literature, and Evaluation and Management Recommendations

Abstract

Acute genital ulcers rarely occur in nonsexually active young girls. When present, they can cause significant physical and emotional distress for the patient and her parents, and prompt an evaluation for sexual abuse and sexually transmitted diseases. With this review, we aim to further characterize acute genital ulcers in nonsexually active young girls by reviewing the medical records of patients with this disorder and to offer an approach to the diagnosis, evaluation, and treatment of acute genital ulcers based on our understanding and knowledge of this condition. We retrospectively review our understanding and knowledge of acute genital ulcers in nonsexually active girls at a pediatric hospital. A review of the recent literature on acute genital ulcers and a multidisciplinary approach to the diagnosis, evaluation, and treatment of acute genital ulcers are also presented. Twelve patients presented with acute genital ulcers, 11 of which were hospitalized for evaluation and pain management. Extensive work-up failed to reveal a specific infectious or autoimmune etiology in all but one patient, who was diagnosed with acute mycoplasma pneumonia. Acute genital ulcers in nonsexually active young girls likely represent a form of idiopathic vulvar aphthosis. Evaluation of a first episode of acute genital ulcers with mild prodromal symptoms should be limited. Treatment consists primarily of supportive care and symptom relief.

Mycoplasma pneumoniae as a cause of vulvar ulcers in a non-sexually active girl: a case report

“…Systemic use of anti-bacterial drugs or anti-viral drugs does not appear to alter the course of the disease [2]. This was also obvious in our case where her skin lesions significantly improved with local care while the M. pneumoniae infection was still active and required the administration of antimicrobial treatment such as azithromycin.…”

“…Since this first description, several additional possible causes have been reported in the literature. In most cases, symptoms consistent with a viral illness precede the development of the ulcers and the differential diagnosis includes infectious agents [2]. Several case reports and case series have associated these vulvar ulcers in non-sexually active females with viral infections such as Epstein–Barr virus [3], cytomegalovirus (CMV), influenza A virus, mumps virus [4, 5], and in some cases with autoimmune disorders such as Behçet’s disease [6] or trauma [7].…”

Úlcera genital aguda de Lipschütz: caso clínico

“…La UGA, también conocida como ulcus vulvae acutum, fue descrita por primera vez en 1913 por Benjamin Lipschütz para referirse a una entidad clínica caracterizada por la súbita aparición de úlceras genitales dolorosas asociadas a fiebre y linfoadenopatías inguinales en adolescentes y jóvenes que no habían comenzado su actividad sexual; atribuyendo en ese entonces su posible causa a la inoculación por el Bacillus crassuss (Lactobacillus de Döderlein) (5). Actualmente múltiples estudios han intentado relacionar esta enfermedad con la primoinfección por el virus Epstein-Barr, infecciones por ureaplasma, mycoplasma, fiebre paratifoidea, virus de la parotiditis y citomegalovirus, sin embargo, su etiopatogenia continúa siendo desconocida (1)(2)(3)(4)(6)(7)(8)(9)(10).…”

“…La úlcera genital aguda (UGA) o úlcera de Lipschütz se caracteriza por la aparición de úlceras genitales en niñas y adolescentes que no han iniciado su actividad sexual. El cuadro es de inicio agudo, con formación de úlceras dolorosas y habitualmente asociado a una fase prodrómica con manifestaciones sistémicas tales como fiebre, odinofagia, cefalea, as-tenia, adinamia, mialgias y ocasionalmente adenopatías inguinales, donde el estudio microbiológico de la lesión descarta una posible etiología infecciosa (1)(2)(3)(4).…”

Ulcus vulvae acutum Lipschütz in two young female patients

“…U lcus vulvae acutum Lipschütz [1] or acute genital ulcer is a distinct clinical entity characterized by sudden painful genital ulceration, occurring mostly in young and virgin girls with malaise, fever and inguinal lymphadenopathy [2][3][4][5][6][7][8]. The cause of this nonherpetic acute genital ulcer is still unknown, although during the 20th century several infectious agents, including EBV [3,[9][10][11][12][13], CMV [14], influenza virus [15], salmonella [16] and toxoplasmosis have been associated with the disease.…”