What causes circumferential ulcers in the vaginal introitus?

From the Guidelines

Circumferential ulcers in the vaginal introitus are most commonly caused by genital herpes, syphilis, or other sexually transmitted infections, and proper diagnosis and treatment are essential to prevent complications and improve quality of life. The causes of these ulcers can be varied, including:

• Genital herpes, caused by herpes simplex virus (HSV-1 or HSV-2), which typically presents with painful, shallow ulcers that may coalesce to form circumferential lesions 1
• Syphilis, which can cause ulcers (chancres) that require treatment with benzathine penicillin G 2.4 million units intramuscularly as a single dose 1
• Other sexually transmitted infections, such as chancroid or lymphogranuloma venereum, which can also cause ulcers in the vaginal introitus 1
• Behçet's disease, a rare condition that can cause mucocutaneous lesions, including genital ulcers, which can be treated with topical measures such as sucralfate suspension or systemic measures such as azathioprine or TNF-alpha antagonists 1
• Crohn's disease or other inflammatory bowel diseases, which can cause ulcers in the vaginal introitus due to fistulas or other complications
• Severe contact dermatitis, which can cause ulcers and other skin lesions in the vaginal introitus

Treatment of circumferential ulcers in the vaginal introitus should be guided by the underlying cause, and may include antiviral medications, antibiotics, or other therapies. For example, suspected herpes can be treated with antiviral medications such as acyclovir (400mg orally three times daily for 7-10 days), valacyclovir (1g orally twice daily for 7-10 days), or famciclovir (250mg orally three times daily for 7-10 days) 1. Proper diagnosis is essential and typically involves physical examination, viral culture, PCR testing, or serologic tests depending on the suspected cause. The ulcers may be accompanied by pain, dysuria, vaginal discharge, or systemic symptoms like fever and lymphadenopathy, and these conditions can disrupt the epithelial integrity of the vaginal tissue, leading to the characteristic circumferential pattern of ulceration around the introitus as the infection or inflammation spreads.

From the Research

Causes of Circumferential Ulcers in the Vaginal Introitus

• Infectious causes:
  • Herpes simplex virus infection 2, 3, 4, 5
  • Syphilis 2, 3, 6
  • Chancroid 2, 3, 6
  • Lymphogranuloma venereum 2, 6
  • Granuloma inguinale (donovanosis) 2
  • Epstein-Barr virus 3, 4
• Noninfectious causes:
  • Sexual trauma 2, 3, 6, 4
  • Psoriasis 2, 3
  • Behçet syndrome 2, 3
  • Fixed drug eruptions 2, 3
  • Autoimmune disease 4
  • Medications 4
  • Squamous cell carcinoma 6

Clinical Presentation and Management

• The clinical presentation of genital ulcers can vary depending on the etiology 6
• A diagnosis of genital ulcers is made through physical examination, observation of genital lesions, and targeted testing 3, 4
• Treatment options vary depending on the cause of the ulcer, and may include antiviral medications, antibiotics, and topical wound care 2, 3