vulvar ulcer
Introduction
Introduction to vulvar ulcer Ulcerationofvulva is an acute skin disorder that occurs in the female vulva. It is more common in the labia minora. It is characterized by one or more ulcers in the vulva, accompanied by fever and pain. It is often secondary to inflammatory and malignant diseases of the vulvovaginal vagina, and sometimes it can also be a reflection of systemic diseases in the vulva and vagina. basic knowledge The proportion of illness: 0.001% Susceptible people: women Mode of infection: non-infectious Complications: vulvar ulcers vestibular gland inflammation fungal vulvitis non-specific vulvitis genital warts soft chancre genital herpes gonorrhea
Cause
Cause of vulvar ulcer
Infection factor (20%):
Herpes simplex virus is the most common cause of vulvar ulcers. This disease is highly contagious, such as sexual intercourse, fetal teratogenicity and the carcinogenic effects of patients themselves, so it has attracted widespread attention.
Autoimmune factors (15%):
In the case of decreased immunity and low resistance, the skin mucosa will be more susceptible to infection, so it may be that there is an ulcer that is not present when the resistance is high.
Disease factors (18%):
Vulvar ulcers are caused by inflammation of the vulva, such as non-specific vulvitis, herpes simplex virus infection, Behcet's disease, vulvar tuberculosis, syphilis, sexually transmitted lymphogranuloma, etc. In addition, about one-third of vulvar cancers, in early manifestations Ulcer, some people think that vulvar ulcer is a special development stage of eye-mouth-genital syndrome. Soft sputum is a disease transmitted by Ducrey Haemophilus through sexual intercourse, and it is also a more common sexually transmitted disease with ulcerative lesions.
Genetic factors (15%):
When the mother has this disease, the fetus may be infected by the bacteria through the placenta, blood or birth canal, causing the fetus to carry a virus.
Organized health or tumor and other factors (10%):
The genital skin and subcutaneous tissue inflammatory reaction, microcirculation disorders, ischemia, infarction, tissue ulceration.
Prevention
Vulvar ulcer prevention
1. Strengthen publicity and education, and prohibit prostitution.
2. Pay attention to personal hygiene.
3. Timely and thorough treatment of early lesions to prevent the development of the lesion to the advanced stage.
4. Before marriage, routine syphilis serological examination during pregnancy.
5. Strictly select blood source, blood donors will be tested for syphilis serum.
6. Vulvar ulcers caused by sexually transmitted diseases should effectively control infected skin lesions and track infection sources. Sexual partners should be treated with or without symptoms. Pay attention to mixed infection with other sexually transmitted diseases, especially if they are combined with HIV infection. An effective preventive method is to avoid contact with infectious skin lesions. The condom can reduce the spread of the disease and it is not suitable for sexual life during the infection.
7. Most of the genital tuberculosis is secondary infection. The primary lesion is mainly tuberculosis. Therefore, active prevention and treatment of tuberculosis is of great significance for the prevention of genital tuberculosis. In addition to strengthening prevention and publicity education, prevention measures should strengthen the health care of children and adolescents. Working, newborns weighing more than 2200g, can be vaccinated after 24 hours of birth, BCG can be re-planted within 3 months if necessary, infants after 3 months until adolescent girls with tuberculin test negative should be BCG vaccination, tuberculosis Pregnancy should be avoided during the active period. In addition, genital tuberculosis patients may have tuberculosis in their vaginal secretions and menstrual blood, and isolation should be strengthened to avoid infection.
Complication
Vulvar ulcer complications Complications vulvar ulcer vestibular glandular fungal vulvitis non-specific vulvitis genital warts soft chancre genital herpes gonorrhea
Complications 1. Acute vulvar ulcers: caused by vulvitis of various causes, usually a symptom manifestation of vulvitis lesions.
Complications 2, vestibular gland inflammation: This symptom is more common in women of childbearing age, mainly because the vestibular gland is caused by bacterial infections such as staphylococci, streptococci, and Escherichia coli, causing acute inflammation.
Complications 3, fungal vulvitis: This type of vulvitis is a vulvitis caused by a yeast-like infection, often coexisting with fungal vaginitis.
Complications 4, sexually transmitted diseases: In the pathogenesis of vulvar condyloma, soft chancre, genital herpes, gonorrhea and other sexually transmitted diseases, there will be inflammation in the vulva.
Complications 5, non-specific vulvitis: not paying attention to health and weakness in life, can make women's vulva easily invaded by bacteria, causing vulvitis, such as cervix, vaginal inflammation.
Symptom
Vulvar ulcer symptoms Common symptoms Perineal ulcers, papules, urgency, edema, pustules, severe pain, vaginal discharge, granuloma, purulent discharge
Ulcers can be seen in various parts of the vulva, with the labia minora and the inner side of the labia majora, followed by the vestibular mucosa and the vaginal opening. The ulcer can exist alone, or several ulcers can be merged into one large ulcer. The vulvar ulcer can be acute. Or chronic:
Acute vulvar ulcer
(1) Non-specific vulvitis: ulcers occur mostly after scratching, and may be accompanied by symptoms such as hypothermia and fatigue, local pain is severe, ulcers are superficial, the number is small, and there is obvious inflammation around.
(2) Herpes virus infection: acute onset, after exposure to herpes simplex virus infection source, there is usually 2 to 7 days of incubation period after fever, discomfort, inguinal lymphadenopathy and herpes, starting from multiple herpes, herpes after ulceration Superficial multiple ulcers, severe pain, ulcers involving the labia minora, especially on the medial side, 50% to 80% of cases involving the vagina, urethra and cervix, ulcers vary in size, bottom grayish yellow, surrounding margin Slightly elevated, and highly congested and edema, ulcers often heal naturally within 1 to 2 weeks, but often relapse, herpes simplex virus due to involvement of the vagina, urethra, etc., patients often accompanied by a large number of vaginal discharge, vaginal discharge is initially a transparent slurry, followed by turbidity The thin pus, and finally a yellow purulent leucorrhea due to bacterial infection, accompanied by urinary symptoms: such as urgency, difficulty urinating.
(3) Behcet's disease: Acute vulvar ulcer is common in Behcet's disease, that is, eye-mouth-genital syndrome. In the past, acute vulvar ulcer was considered as a benign ulcer caused by non-contact infection caused by crude bacilli. Vulvar ulcer is a developmental stage of Behcet's disease, which can occur simultaneously or sequentially with eye and oral lesions. Ulcers can occur in various parts of the vulva, and the medial and lateral vaginal and vestibular vestibules are more frequent. It is clinically divided into 3 types, which can occur alone or in combination, with the most severe gangrene.
1 gangrene type: more systemic symptoms first, such as fever and fatigue, the lesions are red and swollen, the edge of the ulcer is not neat, there is a phenomenon of excavation, local pain is heavy, the surface of the ulcer is attached with a lot of pus, or the yellow to gray black necrosis Pseudomembrane, after removal, the basement is uneven, the lesion develops rapidly, can cause the labia minora defect, the appearance is similar to vulvar cancer, but the edge and the base are soft and no infiltration.
2 squat type: more common, general symptoms are mild, the course of disease is slow, the number of ulcers is more, shallower, the surrounding area is red and swollen, the edges are not neat, there may be digs, often heal within a few weeks, but often healed in the old lesions At the stage, new ulcers appeared nearby.
3 Miliary type: ulcers, such as needles to rice grains, the number is large, the recovery is fast, and the symptoms are mild.
(4) Sexually transmitted diseases such as syphilis, soft chancre and sexually transmitted lymphogranuloma can cause vulvar ulcers.
1 syphilis: syphilis vulvar ulcers can occur in the first and second stages of syphilis, syphilis rash can occur on the surface of the syphilis after 2 to 4 weeks of incubation period, the initial syphilis lesions in the spiral invasion of the local complication, that is, hard squat, It is characterized by painless red inflammatory induration, round, 1~2cm in diameter, shallow ulcer on the surface, neat edges, peripheral bulge, smooth sore surface, dark red, serous purulent discharge on the surface, ulcers are mostly single It is located in the labia majora and labia, and can also be found in the clitoris, urethra or cervix.
2 soft squat: ulcers are often multiple, females with an average of 4 to 5 ulcers, then ulcers can be planted by themselves, and can form clusters of small ulcers around them, ulcers usually heal after 1 to 2 months, the initial There is an inflammatory small papule in the affected part, and there is redness around it. It becomes pustule in 1-2 days. After rupture, it forms erosion. Then it forms an ulcer. The shape of the ulcer varies from 1 to 20 mm in diameter and the edge is rough and sloped. The realm is clear, surrounded by redness, the base is soft and deep, covered with gray or yellow necrotic purulent secretions, removes the sputum purulent secretions, revealing a granuloma-like base, which is tender and prone to bleeding.
3 sexually transmitted lymphogranuloma begins as a single papule and herpes, blisters or pustules, no pain, no infiltration, and then rupture into erosion or shallow ulcers, ulcers occur in the vestibular, labia minora, vaginal opening and around the urethra The shape of the lesion is regular, the edge is flat, and the surface is superficial. After several days to half a month, it heals itself without leaving scars.
2. Chronic vulvar ulcer
(1) tuberculosis: vulvar tuberculosis is rare, even secondary to severe lung, gastrointestinal tract, internal reproductive organs, peritoneal or bone tuberculosis, occurs in the labia or vestibular mucosa, the lesion develops slowly, often a small limitation at the beginning The nodule, soon collapsed into a shallow ulcer that is soft and thin, the shape of the ulcer is irregular, the base is uneven, covered with a cheese-like structure, the lesion is painless, but it can be severely painful after being stimulated or rubbed by urine. The ulcer does not heal for a long time and can spread to the surroundings.
(2) Cancer: vulvar malignant tumors may manifest as papules, nodules or small ulcers in the early stage. The lesions are mostly located in the labia majora, clitoris and posterior joints, with or without vulvar white lesions, cancerous ulcers and tuberculous ulcers. It is difficult to identify with the naked eye and needs to be confirmed by biopsy.
Examine
Examination of vulvar ulcers
According to the history of the disease and the characteristics of the ulcer, if necessary, the secretion smear, culture, syphilis serological test, etc. to confirm the diagnosis.
Exfoliative cytology of genital herpes, enzyme-linked immunosorbent assay.
The smear of the soft sputum secretion, the culture of the secretion, and the Ito-Reenstieno reaction can be found.
Auxiliary examination of sexually transmitted lymphogranuloma: serum complement fixation test, diluted 16 to 64 times positive; smear to find intracellular inclusion bodies; chicken embryo and cell culture to isolate chlamydia.
Syphilis pathogen examination, that is, dark field examination, a small sputum or lymphatic puncture solution can be placed on the slide in the hard sputum of the first stage syphilis, and the saline is added and observed under a dark field microscope, according to the strong refractive power and movement of the spiral body. The way to judge, you can confirm the diagnosis.
Genetic diagnosis of infectious diseases: The use of polymerase chain reaction (PCR) to diagnose genital infections is characterized by rapidity, accuracy and sensitivity.
Soft sputum for histopathological examination: soft chancre and sometimes infected with syphilis, sexually transmitted lymphogranuloma, inguinal granuloma, vaginal herpes, etc., can detect the corresponding pathogenic microorganisms.
Syphilis serological examination: This type of examination is mainly to detect the presence or absence of anti-cardiac antibody (reactive hormone) in the patient, the serum test of Treponema antigen, and the determination of serum-specific antibodies.
Diagnosis
Diagnosis and diagnosis of vulvar ulcer
diagnosis
Patients with acute vulvar ulcers should pay attention to check the presence of lesions in the skin, eyes, oral mucosa, etc. The size, number, shape, and basement of the ulcer should be determined at the time of diagnosis. Sometimes the surface of the ulcer is covered with some secretions, which is easy to miss diagnosis. Careful examination, secretion smear culture, serological examination or histological pathology is helpful for diagnosis.
Differential diagnosis
Genital herpes ulcers vary in size, and blisters are clustered. They are self-healing but often recurrent. It is characterized by eosinophilic inclusions in exfoliated cells.
Ulcers are multiple, varying in size, clear in realm, surrounded by redness, vaginal discharge is gray or yellow, patients have a history of unclean sexual behavior, multiple parts of the body, papules, pustules, ulcers are the characteristics of this disease, secretions coated Tablet or histological pathology helps to identify.
The leucorrhea of sexually transmitted lymphogranuloma is a yellow syrup. The ulcer is superficial, can be self-healing, and forms a fistula. Serological tests, smears can be found in intracellular inclusions, and bilateral inguinal lymphadenopathy occurs after unclean sexual behavior. Softening, rupture, the characteristic manifestation of this disease, can be distinguished from other diseases.
The initial ulcer of syphilis is a single, shallow ulcer, painless, red inflammatory induration, round, 1 to 2 cm in diameter, with serous purulent discharge on the surface, often with systemic scattered rose rash, papule-like syphilis and pus The blister syphilis is often symmetrically distributed, which is the characteristic of this disease. The discovery of treponema pallidum and serological examination in the exudate can make a definite diagnosis and differential diagnosis.
