Reactive genital ulcers

Reactive genital ulcers follow an acute systemic illness. They are non-infective and may be accompanied by oral ulcers. They are also called ulcus vulvae acutum or Lipschütz ulcers.

Clinical features

Reactive acute genital ulcers are often preceded by an acute febrile illness such as tonsillitis, an upper respiratory infection or diarrhoeal illness. They mainly affect adolescent girls but may sometimes arise in adult women. They are not due to sexually transmitted disease.

One or more erosions or deeper ulcers appear suddenly on the vulva. They may be red, yellowish or black due to tissue necrosis. The ulcers may be very painful and result in dysuria (pain passing urine). Similar ulcers may occur in the mouth. They resemble large aphthous ulcers.

The ulcers resolve within a few weeks and rarely recur.

What is the cause?

The cause of reactive acute genital ulcers is not fully understood. They may arise as the result of exuberant immune response to the original systemic infection.

Some cases appear to be provoked by a specific infection, most often Epstein-Barr virus. When ulceration recurs, some patients later prove to have recurrent complex aphthosis or Behçet disease.

Investigations

Viral and bacterial swabs should be taken to rule out infectious causes of genital ulcers such as herpes simplex (genital herpes), syphilis and chancroid.

Further tests will be directed by the symptoms of the underlying illness but should include tests for infectious mononucleosis.

Treatment

Treatment of reactive acute genital ulcers will depend on cause but may include:

• Analgesia such as paracetamol or nonsteroidal anti-inflammatories
• Topical corticosteroid ointment or paste
• Antibiotics if secondarily infected