LIPSCHUTZ GENITAL ULCERATION
By Gary M. White, MD
Lipschutz genital ulceration (LGU), also called genital aphthosis and nonsexual acute genital ulceration is characterized by the development of painful vulvar ulceration in teenage girls. Case reports have associated it with various infections including Epstein-Barr Virus, Mycoplasma fermentans [JAMA Derm 2015;151;1388] and Lyme Disease [JAMA Derm 2014;150;1202].
- Some patients have a history of oral genital contact with a person with infectious mononucleosis.
- Recurrence may occur in up to 1/3 of patients [Eur J Obstet Gynecol Reprod Biol 2016;198;149].
The onset is acute, frequently with fever, of multiple vulvar ulcers, often covered with a dirty, firmly adherent membrane that separates in a few days. Rarely, males with EBV infection develop a penile ulcer. Serologic testing showing a recent EBV infection is helpful.
Workup should include RPR, viral culture, EBV serology, swab for culture, e.g. Haeophilus ducreyi, Neisseria gonorrhea and yeast as well as Lyme serology. The association with Mycoplasma fermentans infection in 3 young female patients [JAMA Derm 2015;151;1388] might suggest ordering IgM serology for M fermentans.
- Supportive care especially focused on pain control.
- Prednisone 1 mg/kg initially and then tapered.
- Make sure the patient can urinate.
- The lesions resolve on their own in a few weeks.
- The combination of a steroid with either a macrolide or tetracycline antibiotic effective against mycoplasma species has been advocated.
Progress in Obstet and Gyn 2011:54
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