Acute Genital Ulcers Research Articles

Lipschütz genital ulcer revisited: is juvenile gangrenous vasculitis of the scrotum the male counterpart?

Since its first description as ulcus vulvae acutum by Benjamin Lipschütz in 1912, the etiopathogenesis of this peculiar genital ulcer remains incompletely understood. In his original description, two different types of genital ulcers were observed and proposed, which were not precisely defined and distinguished in most subsequent reports. The first type is characterized by acute excruciating genital ulcers of first-time onset with self-limited non-recurrent course in association with gravely symptomatic systemic infections, in which a primary Epstein-Barr virus (EBV) infection is later identified to be probably the most common aetiology. The second type of ulcer usually refers to little painful ulcers of unknown etiopathogenesis in the absence of fever or chills and with a slow torpid progression and recurrent nature. Differentiation from idiopathic aphthous ulcers is unclear. The changes of the cervicovaginal microbiota and microbiome in diseased state deserve further clarification. Acute genital ulcers associated with primary EBV infection in women have drawn attention since 1970s, while the corresponding penile ulcers in men were already known in 1950s. First presented in 1973, juvenile gangrenous vasculitis of the scrotum with an acute painful scrotal ulcer preceded by symptomatic pharyngeal infections can be considered as the male counterpart of ulcus vulvae acutum, and the future clinical survey should include primary EBV infection.

Acute Genital Ulcer in a Young Girl

.

Úlcera de Lipschütz como possível manifestação de primo-infeção por vírus Epstein-Barr

Introduction: Lipschutz ulcer is characterized by the rapid onset of painful vulvar ulcerations that typically occurs in sexually inactive adolescent girls, being rare in young children. Although the etiology is unknown, several reports suggest that this entity may be a clinical manifestation of primary infection with Epstein- Barr virus. The diagnosis is made after excluded autoimmune causes, sexually transmitted infections and genital trauma. Case Report: A twelve-month-old girl, admitted with a history of high fever, vulvar ulceration and acute otitis media. Laboratory investigation, demonstrated an acute Epstein-Barr virus infection and ruled out other causes of acute genital ulceration, including autoimmune diseases. Clinical improvement was observed, with resolution of the genital lesions after six weeks, and no recurrence during the ten-month follow-up. Comments: In conclusion if the most common causes of genital ulcer are excluded and there is no sexual contact, Lipschutz ulcer should be included in the differential diagnosis.

Acute genital ulcer in a 14-month-old girl

Acute genital ulcer in a 14-month-old girl

Reactive nonsexually related acute genital ulcers.

The case of a 19-year-old Japanese woman with reactive nonsexually related acute genital ulcers.

Lipschutz Ulcer: a literature review

Initially in 1913, Lipschutz described a vulvar ulcer pattern in female adolescents with no history of sexual intercourse associated with a sudden onset, painful vulvar ulceration, and systemic prodromes. Also known as ulcus vulvae actum or acute genital ulcer, it is a reaction to an infection or an inflammation, which can be systemic or localized in a non-vulvar site. The Lipschutz ulcer (LU) is a diagnosis of exclusion and it has numerous differential diagnoses. For example, sexually transmitted infections (STIs), non-venereal diseases, drug reactions, traumatic and neoplastic causes, among others, should be considered. This study aims to review the diagnosis and treatment of LU, since this disease is often underdiagnosed and constitutes an important differential diagnosis of genital ulcers. It is important to remember that this disease has a non-specific prodromic clinical condition, presenting itself with painful ulcers in the genital region, it is not sexually transmitted, it is self-limited and the treatment is focused on analgesia for better patient ease.

Lipschutz Ulcer: A Rare Cause of Acute Genital Ulcers

Lipschutz Ulcer: A Rare Cause of Acute Genital Ulcers

Non-sexually related acute genital ulcers in a pubertal girl

Non-sexually related acute genital ulcers in a pubertal girl

Lipschütz Ulcers: A Literature Review Based on 79 Cases

Lipschütz ulcers (LU) are acute genital ulcers that occur in women. These ulcers are painful and cause enormous emotional stress to the affected person. It is also of the utmost important for the treating physician to differentiate LU from sexually transmitted ulcers like syphilis, herpes genitalis, and chancroid. The aetiology of LU is not known but recent studies have proposed that it is associated with viral infections, such as the Epstein–Barr virus (EBV) and the cytomegalovirus (CMV), as well as other bacterial infections, such as mycoplasma. Using the PubMed database, articles published between the years of 2003 and 2015 were collected. A total of 20 studies (N=79) fulfilled the inclusion criteria and were selected for analysis. All the published articles were reviewed and relevant data extracted. The age range of patients included in these studies was 17 months to 79 years old. The causative organism was unknown in 50 patients (63%), EBV in 13 patients (16%), Mycoplasma pneumoniae in 4 patients (5%), CMV infections in 4 patients (5%), Mycoplasma fermentans in 3 patients (3.7%), mumps in 1 patient (1.2%), paratyphoid fever in 1 patient (1.2%), parvovirus B19 in 1 patient (1.2%), co-infection of influenza B and adenovirus in 1 patient (1.2%), and co-infection of EBV and CMV in 1 patient (1.2%). Even though viral and bacterial infections had been linked with LU in many of the patients included in these studies, the aetiology remains unknown. Hence, more research is warranted to ascertain the aetiological factors of LU.

Recurrent aphthous stomatitis

Recurrent aphthous stomatitis (RAS) is the most common acute oral ulcerative condition in North America. RAS is divided into a mild, common form, simple aphthosis, and a severe, less common form, complex aphthosis. Aphthosis is a reactive condition. The lesions of RAS can represent the mucosal manifestation of a variety of conditions. These include conditions with oral and genital aphthae such as ulcus vulvae acutum, reactive nonsexually related acute genital ulcers, and Behçet disease. The mouth is the beginning of the gastrointestinal (GI) tract, and the lesions of RAS can be a manifestation of GI diseases such as gluten-sensitive enteropathy, ulcerative colitis, and Crohn disease. Complex aphthosis may also have correctable causes. The clinician should seek these in a careful evaluation. Successful management of both simple and complex aphthosis depends on accurate diagnosis, proper classification, recognition of provocative factors, and the identification of associated diseases. The outlook for patients with both simple and complex aphthosis is positive.

Ulcus vulvae acutum — A case of genital ulcers in adolescent girl

Ulcus vulvae acutum is a rare clinical condition characterized by the presence of multiple acute painful genital ulcers of non-venereal origin associated with systemic symptoms in young women. The aetiopathogenesis of the disease is not fully understood, although recent reports have associated it with the Epstein–Barr virus. Diagnosis is difficult and generally made by exclusion after venereal diseases, and autoimmune, inflammatory, traumatic, and neoplastic causes. We describe a case of adolescent female with an episode of ulcus vulvae acutum associated with infectious mononucleosis. The diagnosis was supported by the clinical symptoms, elevated circulating levels of liver enzymes, positive EBV serology, cervical and inguinal lymphadenomegaly, and hepatosplenomegaly. The patient presented a history of aphthous stomatitis. Negative Pathergy test and the absence of any other related symptoms allowed us to exclude the Behçhet syndrome. Lesions healed with no sequelae or recurrences.

Lipschütz Disease and Epstein-Barr Virus

Lipshutz disease (LD), also known as ulcus vulvae acutum, Epstein-Barr virus (EBV) vulvitis, or reactive nonsexually related acute genital ulcers, typically presents as multiple self-limited, punched-out, and painful ulcers on the labia minora of young, nonsexually active females. These ulcers are commonly associated with EBV, but also with cytomegalovirus (CMV), influenza, mumps, toxoplasmosis, mycoplasma, and salmonella. These authors explored histology in a retrospective review of seven …

Acute Genital Ulcers (AGU) of Unknown Etiology in Adolescent Women

The literature regarding AGU among adolescents is limited and many providers may not be familiar with the natural history of AGU and evaluation and management of AGU.

Unusual Multiple Recurrence of Lipschütz Ulcer of the Vulva in a Young Woman: Case Report and Review of the Literature

Case: A case of 23-year-old woman, virgin, presenting a painful ulcerated vulvar lesion of the vestibular mucosa, with characteristics of Lipschütz ulcer, is reported. Lab tests showed no significant abnormalities, positivity for IgG of HSV1, rubeola, and VZV (with very high title: 2700 mUI/ml), positivity for EBV IgG of VCA and EBNA components and IgM negative (indicating a past infection serologic profile). A moderate insufficiency of Vitamin D was found. A treatment with topical antibiotics and oral antinflammatory drugs was planned and healing was complete without scars in less than 2 weeks. During a period of 6 months the lesion relapsed twice, with the same benign course of the first episode. DISCUSSION: such homogeneous clinical pattern is related to a heterogeneous etiologic spectrum, in which Epstein-Barr virus appears somehow prevalent, but not exclusive, as demonstrated by review of the literature. It is important to have well in mind this differential diagnosis, as Lipschütz ulcer may be overestimated and treated as for other more alarming causes of genital ulceration, with more complicated and unnecessary diagnostic and therapeutic procedures. These four points must be stressed: (1) Acute mononucleosis should always be in a clinician's differential diagnosis of Acute Genital Ulcer (AGU); (2) Failure to consider causes other than genital aphthosis (Behçet) or herpes may expose patients and their family to unnecessary investigations, treatments, and stress; (3) The symptoms of AGU are essentially nonspecific; (4) The physiopathology and aetiology of nonherpetic AGU still constitute broadly unexplored research fields in which further prospective clinical and microbiological studies are needed. Moreover, according to the findings of the reported case, a recurrent Lipschutz ulcer of the vulva in a young women could be related to Herpes Simplex or Varicella Zoster virus.

Acute scrotal ulcers in typhoid Fever: case report and literature review.

Background. In developed countries, typhoid fever is a travel-associated disease that is often overlooked. However, as standard blood and stool culture methods have relatively low sensitivity, diagnosis depends heavily on clinical signs and symptoms and on a high level of suspicion. Methods. Reported here is the case of an 18-year-old male who presented with fever and acute scrotal ulcers and whose blood cultures were positive for Salmonella enterica serotype Typhi. A review of genital ulcers associated with typhoid fever in the literature is discussed. Conclusion. This report suggests that typhoid fever is a differential diagnosis of acute genital ulcers.

Disseminated Lyme Disease Presenting With Nonsexual Acute Genital Ulcers

Nonsexual acute genital ulceration (NAGU) is a rare vulvar skin condition typically affecting girls and young women, characterized by acute onset of singular or multiple painful vaginal ulcers. The etiology of this ulcerative dermatosis has not been identified, although it has been associated with systemic infections. To our knowledge, this is the first report of an association with Lyme disease. A case of a woman with early disseminated Lyme disease presenting with NAGU is reported. A thorough workup ruled out other causes of genital ulceration, and the ulcers completely resolved after treatment with topical steroids and oral doxycycline. Although the etiology of NAGU is unknown, the vulvar ulcers may result from an exuberant immune response to infection. Most patients with NAGU exhibit nonspecific symptoms such as myalgias and fever, suggesting an infectious agent, but the majority have no identifiable pathogen. In addition to previously reported associations with systemic infection, which are reviewed herein, Lyme disease should be considered in women presenting with acute-onset genital ulcers.

Ulcus vulvae acutum Lipschütz in two young female patients

Ulcus vulvae acutum Lipschütz 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 other systemic symptoms. This distressing syndrome is rare and may be presented to dermatologists, gynecologists or pediatricians. Its diagnosis and therapy can be challenging. We present two young female patients with ulcus vulvae acutum. The cause of the disease could not be confirmed in our patients, but, interestingly, both patients had partial IgA deficiency. In the last 100 years, after its first description by Lipschütz, many case reports and series have aimed to identify a specific cause of the disease, without success. These studies mainly focused on infectious agents as causative factors, however, in most cases connection with infection could not be confirmed. Our opinion is that the decreased level of IgA could be a possible explanation for the cause of this syndrome. With our cases we would like to emphasize the possible role of local immunological mechanisms rather than several infectious agents in the development of this little-known disease.

Reproductive health problems and health seeking behavior of female sex workers in Sabon Gari Local Government Area, Zaria, Nigeria

Background: The sexual and reproductive health needs of sex workers have been neglected both in research and public health interventions. Among the reasons for this are the condemnation, stigma and ambiguous legal status of sex work in Nigeria. This study was aimed at determining the reproductive health problems and health-seeking behavior of brothel-based female sex workers (FSW). Materials and Methods: This cross-sectional study was conducted among brothel-based FSW in Sabon-Gari Local Government in Zaria, Nigeria between 1 st January 2011 and 31 st June 2011. A total of 208 FSW were randomly selected and information was obtained with the use of the semi-structured questionnaire. Data entry was done with the help of structured codes in Microsoft Excel. Descriptive analysis was carried out using the statistical package (SSPS 16-University of Bristol). Results: Majority 90.7% of the respondents had experienced reproductive morbidity in the last 3 months. Frequently experienced symptoms were vaginal discharge (63.8%), acute lower abdominal pain (57.5%), menstrual irregularities (37%) and genital ulcer (32.3%). Genital tear occurred in only 25 (9.8%) respondents. Furthermore, 178 (63.6%) had a termination of unwanted pregnancies. Most (32.3%) sought care for their reproductive health problems from chemist shops; followed by the private hospitals in 23.6% of respondents. Others took self-medication for their ailments. Post-treatment success was the most frequently mentioned reason for the choice of place of treatment, followed by finance. Conclusion: The most commonly reported reproductive health problem among FSW was vaginal discharge and many of them have poor health seeking behavior. Health promotion and client sensitive health care services specifically targeting FSW should be developed, packaged and delivered to improve reproductive health of FSW. There should be concerted efforts by the government and other stakeholders in reproductive health to develop a policy framework to addressing the challenges in health of FSW.

Epstein–Barr virus and skin manifestations in childhood

Epstein-Barr virus (EBV) is a human B-lymphotropic herpes virus and one of the most common viruses in humans. Specific skin signs related to EBV infection are the exanthem of mononucleosis, which is observed more frequently after ingestion of amoxicillin, and oral hairy leukoplakia, a disease occurring mostly in immunocompromised subjects with HIV infection. Other more uncommon cutaneous disorders that have been associated with EBV infection include virus-related exanthems or diseases such as Gianotti-Crosti syndrome, erythema multiforme, and acute genital ulcers. Other skin manifestations, not correlated to virus infection, such as hydroa vacciniforme and drug-induced hypersensitivity syndrome have also been linked to EBV. The putative involvement of EBV in skin diseases is growing similarly to other areas of medicine, where the role of EBV infection is being investigated in potentially debilitating inflammatory diseases. The prognosis of EBV infection in healthy, immunocompetent individuals is excellent. However, lifelong infection, which is kept in check by the host immune system, determines an unpredictable risk of pathologic unpredictable scenarios. In this review, we describe the spectrum of non-tumoral dermatological manifestations that can follow EBV primary infection or reactivation of EBV in childhood.

Lipschütz ulcer in a 17-month-old girl: a rare manifestation of Epstein–Barr primoinfection

Lipschütz ulcer is an uncommon entity that is clinically characterised by a flu-like syndrome accompanied by an acute painful necrotic vulvar ulcer. It typically occurs in young women with no sexual contact history, and it is very rare among children. The aetiology is unknown, although recently several reports have related Epstein-Barr virus primary infection with this entity. We report a 17-month-old girl with fever and an acute genital ulcer. All the complementary tests for the most frequent causes of vulvar ulcers yielded negative results, whereas viral serology and polymerase chain reaction technique confirmed the presence of an acute Epstein-Barr virus infection. When main causes of genital ulcer have been excluded, and there is no history of sexual contact, Lipschütz ulcer should be included in the differential diagnosis. Detection of Epstein-Barr virus genome by polymerase chain reaction can lead to an earlier diagnosis.