Differential Diagnosis for Vulvar Lesion
- Single most likely diagnosis
- Genital Herpes: The patient's presentation of a vulvar lesion that began as a papule and progressed to an ulcer with mild burning during urination, along with bilateral inguinal lymphadenopathy, is highly suggestive of genital herpes. The absence of systemic symptoms like fever also aligns with this diagnosis, as primary genital herpes can present with localized symptoms.
- Other Likely diagnoses
- Syphilis (Primary): The presence of a painless ulcer (chancre) with a nonexudative base and raised, indurated margins, accompanied by bilateral inguinal lymphadenopathy, could indicate primary syphilis. The patient's history of multiple sexual partners increases the likelihood of sexually transmitted infections.
- Chancroid: Although less common in developed countries, chancroid caused by Haemophilus ducreyi could be considered due to the patient's sexual history and the presence of a painful ulcer (though the ulcer in this case is described as mildly burning rather than painful). However, the lack of significant pain and the absence of exudate make this less likely.
- Do Not Miss (ddxs that may not be likely, but would be deadly if missed.)
- Malignancy (e.g., Squamous Cell Carcinoma): Although rare in a young patient, any vulvar ulceration that does not heal or has atypical features warrants consideration of malignancy. The presence of an indurated margin could raise suspicion, though the patient's age and the acute onset make this less likely.
- Lymphogranuloma Venereum (LGV): This is another sexually transmitted infection that could present with lymphadenopathy and genital lesions. It's crucial to consider LGV due to its potential for serious complications if left untreated, despite its lower prevalence.
- Rare diagnoses
- Behçet's Disease: This condition can cause genital ulcers that are similar in appearance to those described, along with other systemic symptoms. However, the absence of oral ulcers or other systemic symptoms makes this diagnosis less likely.
- Granuloma Inguinale (Donovanosis): Characterized by painless, beefy-red ulcers without lymphadenopathy, this diagnosis is less likely given the patient's presentation of an ulcer with a nonexudative base and significant lymphadenopathy.