acyclovir and Vulvar-Diseases

Lipschütz ulcers are characterised by a first flare of non-sexually related acute genital ulcers (AGU) occurring in adolescent girls. Epstein-Barr primary infection is the most frequently reported aetiology but other infectious agents are probably implicated. We report the first case of mumps associated with an AGU in a 21-year-old girl. She presented a bilateral parotitis with genital ulcers, and serology confirmed she had mumps. As in our case, most Lipschütz ulcers heal spontaneously within a couple of weeks and the diagnosis should be reconsidered in case of recurrence.

Topics: Acute Disease; Acyclovir; Antiviral Agents; Female; Humans; Immunoglobulin G; Immunoglobulin M; Mumps; Mumps virus; Skin Ulcer; Treatment Outcome; Valacyclovir; Valine; Vulvar Diseases; Young Adult

To date there have been only five reported cases of females with genital ulceration associated with primary Epstein-Barr virus infection. We describe two further patients and review the clinical features of all seven cases, noting the typical features, particularly purple ulcer margins and systemic symptoms, which should alert the physician to consider this diagnosis.

Topics: Acyclovir; Adolescent; Antiviral Agents; Female; Herpes Genitalis; Herpesvirus 4, Human; Humans; Ulcer; Vulvar Diseases

Topics: Acyclovir; Diagnosis, Differential; Female; Herpes Genitalis; Humans; Infant, Newborn; Pregnancy; Pregnancy Complications, Infectious; Recurrence; Vulvar Diseases

Substantial advances have been made in our understanding of HSV and genital herpes. The molecular biology of viral structure and function and the pathogenesis of infection have been elucidated to a large degree, and epidemiologic investigations, based on reliable type-specific assays, have been done. Diagnostic techniques have been refined, and the value of therapy has been defined. Currently, management strategies for pregnant women and their neonates are based on data rather than hypothesis, and rational counseling is feasible. The next major advance in the field would be the availability of a safe and effective vaccine, the development and investigation of which is being pursued vigorously.

Topics: Acyclovir; Condoms; Diagnosis, Differential; Female; Gynecology; Herpes Genitalis; Humans; Incidence; Mass Screening; Pregnancy; Pregnancy Complications, Infectious; Pregnancy Outcome; Prevalence; Primary Prevention; Recurrence; Risk Factors; Vaginal Diseases; Virus Shedding; Vulvar Diseases

Patients with vulval aphthae, also termed Lipschütz ulcers, often present to genitourinary medicine clinics. Typically, these ulcers present as acute, painful, vulval ulcers in young women and adolescents. The aetiology is unknown, and often these ulcers are accompanied by flu-like symptoms. Previous case reports have linked such lesions to acute viral infections such as Epstein-Barr virus, cytomegalovirus and influenza A. We report the first case of influenza B virus and adenovirus infections associated with this presentation.

Topics: Acyclovir; Adolescent; Antiviral Agents; Female; Humans; Influenza B virus; Influenza, Human; Polymerase Chain Reaction; Skin Ulcer; Treatment Outcome; Ulcer; Vulvar Diseases

This is the case of a black African woman who presented with three distinct episodes of herpes simplex virus (HSV) infection unresponsive to first-line therapy. Clinical and virological resistance to aciclovir therapy was demonstrated, and although the first two episodes manifested as the deep ulceration often associated with HIV/HSV coinfection, the third was an atypical hypertrophic lesion. This is despite her CD4 count being persistently above 300 and there being no previous diagnosis of AIDS.

Topics: Acyclovir; Adolescent; Anti-Retroviral Agents; Drug Resistance, Viral; Female; Herpes Simplex; HIV; HIV Infections; Humans; Pregnancy; Simplexvirus; Valacyclovir; Valine; Vulvar Diseases

Topics: Acyclovir; Adult; Antiviral Agents; Chronic Disease; Female; Herpes Genitalis; HIV Infections; Humans; Vulvar Diseases

A 34-year-old healthy woman presented with a 15-month history of persistent, nonhealing vulvar ulcerations due to herpes simplex virus (HSV) type 2. Extensive dermatologic workup and serial skin biopsies failed to reveal an underlying vulvar dermatosis or autoimmune bullous disorder. Virologic studies revealed resistance to acyclovir in vitro due to deficiency in thymidine kinase activity. Serum antibody to human immunodeficiency virus was negative on two occasions, separated by 1 year. Immunologic evaluation showed normal HSV-specific proliferative and CD8 cytotoxic T lymphocyte responses as well as normal NK cell function. Vulvar lesions failed to heal in association with trials of topical trifluorothymidine and oral valacyclovir but resolved completely with the application of 1% foscarnet cream. No recurrence of HSV has been observed in 24 months of follow-up to date.

Topics: Acyclovir; Antiviral Agents; Chronic Disease; Drug Resistance, Microbial; Female; Foscarnet; Humans; Immunocompetence; Simplexvirus; Thymidine Kinase; Ulcer; Valacyclovir; Valine; Vulvar Diseases

Topics: Acyclovir; Chronic Disease; Drug Resistance, Microbial; Female; Herpes Genitalis; Herpesvirus 2, Human; Humans; Immunocompetence; Middle Aged; Recurrence; Vulvar Diseases

Topics: Acyclovir; Child; Female; Humans; Infectious Mononucleosis; Ulcer; Vulvar Diseases

We call attention to a group of patients with chronic vulvar burning (vulvodynia), who do not have apparent infections or easily discernible abnormal physical findings, but who on simple sensory testing have allodynia, hyperalgesia, hyperpathia, and hypoesthesia in varying permutations within the areas innervated by the pudendal nerve. We propose that pudendal neuralgia (pain along the pudendal nerve) is one of the causes of idiopathic vulvodynia. In those patients in whom a neurologic, metabolic, infectious, traumatic, or malignant cause for neuralgia is not found, medical management with tricyclic antidepressants, antiepileptic agents, or both may prove helpful. Awareness of this entity will lead to earlier diagnosis, treatment, and reassurance of patients with chronic vulvar burning.

Topics: Acyclovir; Antidepressive Agents, Tricyclic; Female; Herpes Simplex; Humans; Neuralgia; Perineum; Vulva; Vulvar Diseases