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Women's Health

Herpes?

05/08/2006

Question:

I have a shallow looking sore on I`m my vulva. I noticed the other day before the sore became apparent that I wiped myself kind of hard after using the bathroom. I remember it hurt like maybe I knocked something off. Well, a couple of days later this sore appeared, and it was bleeding like crazy. Now it`s sort of shallow looking, and is still bleeding whenever I mess with it. I`m not sexually active, but I used to masturbate, which I heard can sometimes transmit herpes from oral to genital, although I don`t ever recall having cold sores. The part of the vulva it`s on is near some hairs, so could this have been a hair follicle and I knocked it off? Or does this sound like herpes?

Answer:

Genital ulcers are a common cause of office visits to Primary Care offices, Emergency Rooms and STD Clinics in the United States. Herpes Simplex Virus Type 2 (HSV) is the most common cause of genital ulcers in sexually active young adults in the United States, followed by Syphilis and Chancroid. Noninfectious causes of genital ulcers include trauma, fixed drug reaction (i.e., to a new medication), Behcets disease (autoimmune disease associated with oral and genital ulcers), and cancer (very uncommon). HSV 2 typically causes genital ulcers, while HSV 1 causes cold sores and oral ulcers. HSV is most commonly transmitted sexually, but can also be transmitted by direct contact with mucus membranes or infected skin.

Genital herpes ulcers are typically painful and associated with a burning or tingling sensation in the vaginal area. Patients usually have multiple lesions, which may look like blisters, and can bleed if traumatized. A large number of patients who have newly acquired genital herpes may have a recurrent infection in the 1st and 2nd years after acquisition, but these outbreaks are usually less severe.

Diagnosis of genital ulcers is made by a complete physical exam, certain laboratory tests, and direct testing on the ulcer itself. Herpes is diagnosed by a Tzanck smear, which is a special swab of the ulcer fluid, and/or by viral culture of the ulcer itself.

Syphilis is diagnosed by multiple methods, most commonly blood work. Chancroid is diagnosed with a swab of the ulcer as well, looking for the causative bacteria.

Genital herpes is treated with antiviral medications, including acyclovir, famcyclovir and valacyclovir, for 7-10 days. All are equally effective in reducing symptoms and clearing ulcers; acyclovir is the least expensive.

Patients are encouraged to avoid sexual activity during active outbreaks, and use condoms at other times. Any patient with genital herpes is at high risk for other sexually transmitted diseases as well, and should be screened for these.

Any genital ulcer requires a thorough physical exam and testing as mentioned above. Although you may simply have an irritated or infected hair follicle causing your symptoms, you should see your physician to determine if you have another more serious, underlying cause. If indeed you have genital herpes, the risk of transmission to others either sexually or by direct contact, is very high.

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Response by:

Case Western Reserve University Shazia Ahmed Khan, MD
Formerly, Assistant Professor of Medicine
Department of Medicine
School of Medicine
Case Western Reserve University
Shazia Ahmed Khan, MD