生殖器疱疹是最常见的性传播疾病,最常见的是由通常通过性传播的单纯疱疹病毒-2(HSV2)引起(1)。我们报告了一例28岁的女性,患有罕见的HSV表现,在首次出现症状后不到48小时迅速导致阴唇坏死和破裂。病例介绍我们报告了一名28岁女性患者的病例,该患者到我们的诊所就诊,患有两个小阴唇的疼痛性坏死性溃疡,尿潴留,和极端的不适(图1)。患者在外阴疼痛和灼烧感和肿胀之前几天报告了无保护的性交。由于排尿时强烈的灼热和疼痛,立即插入了导尿管。阴道和子宫颈覆盖有溃疡和地壳病变。Tzanck涂片检查显示多核巨细胞,聚合酶链反应(PCR)分析对HSV感染有决定性作用,而梅毒,肝炎,艾滋病毒检测呈阴性。由于口唇坏死进展,患者入院后两天出现发热,我们在全身麻醉下进行了两次清创,患者接受全身抗生素和阿昔洛韦。关于后续访问,四周后,两个阴唇都有完全上皮化。讨论原发性生殖器疱疹,经过短暂的潜伏期,多发双侧丘疹,囊泡,疼痛的溃疡,结壳出现了,在15至21天的时间内解决(2)。临床非典型表现包括生殖器疾病的不寻常部位或非典型形态形式,外生性(疣状或结节性)表面溃疡病变,主要见于HIV患者,裂缝,局部复发性红斑,不愈合的溃疡,硬化性苔藓患者外阴有灼热感(1)。我们的多学科小组讨论了这个病人,正如我们所知,溃疡可能与罕见的恶性外阴病理有关(3)。诊断的金标准是来自病变的PCR(1)。抗病毒治疗应在初次感染后72小时内开始,并持续7至10天。结论去除无活力组织的过程称为清创术。只有当疱疹性溃疡不能自己愈合时,清创术才是必要的,这是当坏死组织,可以藏有细菌,可能会导致更广泛的感染形成。去除坏死组织加速愈合并降低进一步并发症的风险。
INTRODUCTION Genital herpes is the most common sexually transmitted disease and is most commonly caused by herpes simplex virus -2 (HSV2) which is usually sexually transmitted (1). We report a
case of a 28-year-old woman with an unusual
case of HSV presentation that rapidly resulted in necrosis and rupturing of the labia less than 48 hours after first appearance of symptoms.
CASE PRESENTATION We report the
case of a 28-year-old female patient who presented to our clinic with painful necrotic ulcers of both labia minora, urinary retention, and extreme discomfort (Figure 1). The patient reported unprotected sexual intercourse a few days prior to the pain and burning sensation and swelling of the vulva. A urinary catheter was inserted immediately due to intense burning and pain while urinating. The vagina and cervix were covered with ulcerated and crustal lesions. The Tzanck smear test showed multinucleated giant cells, and polymerase chain reaction (PCR) analyses were conclusive for HSV infection, while syphilis, hepatitis, and HIV tests were negative. Since there was progression of the labial necrosis and the patient became febrile two days after admission, we performed debridement twice under systemic anesthesia, and the patient receive systemic antibiotic together with acyclovir. On the follow-up visit, four weeks later, both labia had epithelized completely. DISCUSSION In primary genital herpes, after a short incubation period, multiple bilaterally located papules, vesicles, painful ulcers, and crusts appear, which resolve over a period of 15 to 21 days (2). Clinically atypical presentations include either unusual sites or atypical morphological forms of genital disease, exophytic (verrucoid or nodular) superficially ulcerated lesions, mostly seen in patients with HIV, fissures, localized recurrent erythema, nonhealing ulcers, and burning sensation in the vulva in a patient with lichen sclerosus (1). This patient was discussed in our multidisciplinary team, as we know that ulcerations could be associated with rare malignant vulvar pathology (3). The golden standard for diagnosis is PCR from the lesion (1). Antiviral therapy should be initiated within 72 hours of primary infection and continued for 7 to 10 days. CONCLUSION The process of removing nonviable tissue is called debridement. Debridement is only necessary when a herpetic ulceration is not healing on its own, which is when necrotic tissue that can harbor bacteria that may cause more extensive infections is formed. Removing the necrotic tissue speeds up healing and reduces the risk of further complications.