Can Epstein-Barr virus (EBV) cause genital ulcers?

From the Guidelines

Epstein-Barr virus (EBV) is not a common cause of genital ulcers, and other pathogens such as herpes simplex virus, syphilis, and chancroid are more frequently associated with this condition. According to the American Academy of Pediatrics [ 1 ], genital ulcers are commonly caused by herpes simplex virus (HSV), syphilis, or chancroid, which are sexually transmitted. Although EBV can cause a wide range of symptoms and can affect multiple organ systems, it rarely manifests as genital ulcers because the virus primarily targets B lymphocytes in the oropharyngeal tissue and blood, rather than genital epithelial cells. Some key points to consider when evaluating genital ulcers include:

• The presence of ulcers on the external genitalia or in the vagina, which can be signs of an STI or other dermatologic conditions [ 1 ]
• The importance of performing specific tests, such as viral cultures or serologic tests, to identify the cause of genital ulcers [ 1 ]
• The need to consider other potential causes of genital ulcers, such as aphthous spectrum ulcers or those caused by EBV infection, although these are less common [ 1 ] It's worth noting that the Centers for Disease Control and Prevention [ 1 ] also emphasize the importance of considering multiple potential causes of genital ulcers, including genital herpes, syphilis, and chancroid, and highlight the need for proper diagnosis and treatment to prevent complications and improve patient outcomes.

From the Research

Epstein-Barr Virus and Genital Ulcers

• Epstein-Barr virus (EBV) can cause genital ulcers, although it is an uncommon manifestation of primary EBV infection 2, 3, 4.
• There have been reported cases of EBV-associated genital ulcers in females, with a median age of 14.5 years, and most cases heal within 18 days 2.
• Genital ulcers caused by EBV are often painful and can be associated with systemic infections, such as infectious mononucleosis 3, 5.
• EBV should be considered in the differential diagnosis of genital ulcers, especially in cases where a diagnosis of a venereal infection has important psychosocial consequences 4.
• Other causes of genital ulcers, such as herpes simplex virus, syphilis, and chancroid, should also be considered and ruled out through specific testing 6.

Characteristics of EBV-Associated Genital Ulcers

• EBV-associated genital ulcers are typically acute and self-limited, with a non-recurrent course 2, 5.
• The ulcers are often preceded by symptomatic pharyngeal infections 5.
• Juvenile gangrenous vasculitis of the scrotum may be considered the male counterpart of EBV-associated genital ulcers in females 5.

Diagnosis and Management

• Diagnosis of EBV-associated genital ulcers can be made through clinical evaluation, serologic testing, and histopathologic examination 2, 3.
• Management of genital ulcers should include consideration of non-infectious etiologies, such as sexual trauma, psoriasis, and fixed drug eruptions 6.