Sexually Transmitted Diseases - I. I. Mavrov 2005

Non-Venereal Inflammatory Diseases of the Genital Organs
Acute Vulvar Ulcer

Acute vulvar ulcer (ulcus vulvae acutum), also known as Chapin-Lipschütz ulcer, is a rare bacterial condition of the female external genitalia characterized by The formation of purulent ulcers. It is most frequently observed in young girls and women. Several theories exist regarding its Etiology. Some authors suggest that the causative agents are the gram-positive Bacillus crassus and Döderlein's vaginal bacillus, which normally saprophytize the vaginal mucosa and become pathogenic when the body's immune defenses are weakened. Conversely, other researchers argue that the detection of Bacillus crassus holds no etiological significance, as it may be entirely absent in this pathology.

Several authors classify this condition as a probable manifestation of exudative or nodular erythema, or more commonly, as aphthosis triggered by an unidentified virus.

Clinical presentation. Several forms of acute vulvar ulcer have been described. The typical form manifests as single or multiple painful ulcers on the Labia minora, and less frequently on the Labia Majora, varying in size, with well-defined boundaries and somewhat undermined edges. The condition appears abruptly against a Background of low-grade fever and runs an acute course over several weeks. In the subacute form, ulcers develop successively and may recur after resolution. The miliary form is characterized by multiple superficial sores with a narrow, faint rim of hyperemia and scanty purulent discharge, resembling aphthae, with an acute or subacute course. Lymph Nodes are not enlarged, though relapses are possible. The gangrenous form presents as a solitary chancre-like necrotic ulcer up to 3 cm in diameter, surrounded by markedly hyperemic and edematous Tissues. The acute stage is accompanied by high fever (up to 40 °C) and severe burning pain in the external genitalia. Regional lymph nodes are enlarged.

In some cases, acute vulvar ulcer is associated with aphthous-ulcerative lesions on the oral mucosa (on the inner surface of the Lips), erythematous-exudative Skin rashes, erythema nodosum, and chronic recurrent aphthosis. These presentations may be accompanied by general malaise, fever, arthralgia, Conjunctivitis, uveitis, and iridocyclitis.

Diagnosis is established based on the clinical picture and the results of bacterioscopic examination of the ulcer discharge. Differential diagnosis should rule out Syphilis, ulcerative tuberculosis, certain forms of erythema multiforme, Chancroid, genital herpes, and Behçet's Disease. Similar ulcerative processes may also manifest as a complication of typhoid or other infections; roughly 10% of patients with typhus have been observed to develop acute vulvar ulcers. Conversely, acute vulvar ulcers have occasionally been documented as a prodromal or concurrent sign of typhus.

Treatment. Autohemotherapy, gamma globulin administration, desensitizing agents, and multivitamin complexes are recommended. Topical management involves antiseptic powders and corticosteroid ointments containing Antibiotics; for marked edema, wet compresses (using a 0.25% potassium permanganate solution or a 0.1% aqueous rivanol solution) are indicated. Broad-spectrum antibiotics are prescribed for the gangrenous form. Preventive measures focus on strengthening overall immune resilience and maintaining rigorous personal hygiene.