Acute genital ulceration (Lipschütz ulcer)
- Robert Sidbury, MD, MPH
Robert Sidbury, MD, MPH
- Associate Professor - Department of Pediatrics
- University of Washington School of Medicine
Acute genital ulceration, also known as Lipschütz ulcer or "ulcus vulvae acutum," is an uncommon, nonsexually transmitted condition characterized by the rapid onset of painful necrotic ulcerations of the vulva or lower vagina. It typically occurs in sexually inactive adolescent girls or young women and may be preceded by influenza-like or mononucleosis-like symptoms. Acute genital ulceration has been associated with acute Epstein-Barr virus (EBV) infection or other viral and bacterial infections [1-4]. However, in many cases a cause cannot be determined [5-7].
This topic will review the clinical manifestations, diagnosis, and management of acute genital ulceration. Other causes of vulvar ulceration are discussed separately. (See "Vulvar lesions: Differential diagnosis based on morphology", section on 'Ulcers' and "Approach to the patient with genital ulcers".)
The precise incidence of acute genital ulceration is unknown. In a few cases series, the average age at onset was 12 to 29 years [1,4,8]. There are rare reports of acute genital ulcerations in adult women and young children [9,10].
ETIOLOGY AND PATHOGENESIS
Several lines of evidence suggest that acute genital ulceration may be a manifestation of primary infection with Epstein-Barr virus (EBV) [1,5,11-13]. EBV might reach the genital mucosa via hematogenous spread of EBV-infected lymphocytes or Langerhans cell precursors or through autoinoculation with saliva, urine, or cervicovaginal fluid . (See "Clinical manifestations and treatment of Epstein-Barr virus infection", section on 'Primary infection'.)
There are isolated reports of acute genital ulceration associated with infection with other viruses and bacteria, including cytomegalovirus , influenza A virus , influenza B virus , mumps virus , salmonella , and mycoplasma , and with disseminated Lyme disease . In one report, genital ulcers were the first manifestation of acute myeloid leukemia in a 28-year-old woman . However, in most cases a cause cannot be determined [5-7].
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