From the Guidelines
Vaginal ulcers should be diagnosed and managed based on the underlying cause, with a focus on reducing morbidity, mortality, and improving quality of life. The most common causes of vaginal ulcers include genital herpes (HSV), syphilis, chancroid, lymphogranuloma venereum, and non-infectious conditions like Behçet's disease or aphthous ulcers. For treatment, the underlying cause must be identified through physical examination and laboratory testing, such as HSV nucleic acid amplification test (NAAT)/polymerase chain reaction (PCR) diagnostic assays, which have >90% sensitivity and specificity 1. Some key points to consider in the management of vaginal ulcers include:
- Genital herpes is typically treated with antiviral medications like acyclovir, valacyclovir, or famciclovir 1.
- Bacterial causes like syphilis require antibiotics such as benzathine penicillin G 1.
- For symptomatic relief, patients can use sitz baths, wear loose cotton underwear, avoid irritants like perfumed products, and take over-the-counter pain relievers.
- It's crucial to abstain from sexual activity until ulcers heal completely to prevent transmission.
- Patients should seek medical attention promptly when vaginal ulcers appear, as early diagnosis and treatment can prevent complications and reduce transmission risk. In cases of Behçet's disease, treatment of mucocutaneous involvement depends on the perceived severity by the doctor and the patient, and may include topical measures, colchicine, azathioprine, IFNa, and TNFa antagonists 1. Overall, the management of vaginal ulcers requires a comprehensive approach that takes into account the underlying cause, patient symptoms, and quality of life.
From the FDA Drug Label
Genital ulcer disease in men due to Haemophilus ducreyi (chancroid). Due to the small number of women included in clinical trials, the efficacy of azithromycin in the treatment of chancroid in women has not been established
The FDA drug label does not answer the question about vaginal ulcers.
From the Research
Causes of Vaginal Ulcers
- Vaginal ulcers can be caused by infectious agents such as herpes simplex virus, syphilis, chancroid, lymphogranuloma venereum, granuloma inguinale (donovanosis), secondary bacterial infections, and fungi 2, 3, 4
- Noninfectious etiologies, including sexual trauma, psoriasis, Behçet syndrome, and fixed drug eruptions, can also lead to vaginal ulcers 2, 3, 5
Diagnosis of Vaginal Ulcers
- Diagnosis of vaginal ulcers is based on clinical presentation, patient history, and physical examination 6, 5
- Laboratory tests such as serologic tests for syphilis, darkfield microscopy or direct fluorescent antibody testing for Treponema pallidum, culture or polymerase chain reaction test for herpes simplex virus, and culture for Haemophilus ducreyi may be necessary to aid in diagnosis 2, 3
Treatment of Vaginal Ulcers
- Treatment of vaginal ulcers depends on the underlying cause, and may include antiviral medications such as acyclovir, famciclovir, and valacyclovir for herpes simplex virus infection 2
- Antibiotics such as penicillin G benzathine, ceftriaxone, azithromycin, ciprofloxacin, and erythromycin may be used to treat bacterial infections such as syphilis and chancroid 2, 3
- Treatment of noninfectious causes of vaginal ulcers varies by etiology, and may include topical wound care for ulcers caused by sexual trauma, or consideration of subcutaneous pegylated interferon alfa-2a for ulcers caused by Behçet syndrome 2