Highlights
- •There are multiple etiologic factors the primary provider must consider when delivering care for the patient with genital ulcers.
- •Differentials will include sexually transmitted infection (STI) or venereal origins, especially herpes simplex virus I or II, which should be among the first differential diagnoses one considers.
- •Clinicians need to be aware of other rare, but possible, etiologic factors for this extremely painful and debilitating illness.
- •The diagnosis of nonsexually acquired genital ulcers is dependent on the art of exclusion and requires thorough history, physical examination, and diagnostic laboratory testing in confirming the diagnosis.
- •Additionally, the clinician must realize that patients and significant others may be very confused and concerned about the presenting symptoms that mimic STI-related symptoms, which may cause psychological stress, especially in the adolescent patient.
Abstract
This case study challenge describes the case of a 13-year-old female who presented
to a primary care clinic with extremely painful vaginal lesions. She also had generalized
symptoms such as fatigue, malaise, and low-grade fever. An adolescent with these presenting
symptoms may make the nurse practitioner immediately consider the common sexually
transmitted diseases often presented at primary and urgent care settings, yet there
are many differentials that should be considered. Despite what might seem obvious,
a thorough history, physical examination, and diagnostic testing are imperative to
avoid misdiagnosis.
Keywords
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References
- Lipschütz ulcer: an unusual diagnosis that should not be neglected.Rev Bras Ginecol Obstet. 2021; 43: 414-416https://doi.org/10.1055/s-0041-1729147
- Genital ulcers: differential diagnosis and management.Am Fam Physician. 2020; 101: 355-361
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- Acute genital ulceration (Lipschutz ulcer). UpToDate.
- Nonsexually acquired acute genital ulceration: a commonly misdiagnosed condition.Gulf J Dermatol Venereol. 2018; 25: 1-12
- Quick consult: symptoms: fever, vulvodynia, vaginal ulcers.Emerg Med News. 2019; 41: 11-12https://doi.org/10.1097/01.EEM.0000559976.21608.30
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Biography
Daisy G. Mullassery, DrNP, WHNP-BC, is a Assistant Professor-Clinical at the University of Texas Health Science Center Cizik School of Nursing in Houston and can be contacted at [email protected]
Biography
Rebecca Tsusaki, PhD, WHNP-BC, is a Assistant Professor-Clinical at the University of Texas Health Science Center Cizik School of Nursing.
Article info
Publication history
Published online: March 08, 2023
Publication stage
In Press Corrected ProofFootnotes
In compliance with standard ethical guidelines, the author reports no relationships with business or industry that would pose a conflict of interest.
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© 2022 Elsevier Inc. All rights reserved.
