2. This 13-year-old presents with sudden-onset vulvar pain and sores. The child developed a sore throat and low-grade fever 3 days earlier, with vulvar pain and vulvar dysuria the next day. Oral acyclovir was prescribed for herpes simplex virus infection, but the girl’s condition has not improved. She claims sexual abstinence, and her mother believes her.
Diagnosis: Vulvar aphthae, believed to be of hyperimmune origin, are often precipitated by a viral syndrome. They are most common in girls aged 9 to 18 years.
Aphthae are uncommon and under-recognized on the vulva. Genital aphthae are usually much larger than oral aphthae. Most patients are mistakenly evaluated and treated for sexually transmitted infection, but the large, well-demarcated, painful, nonindurated, deep nature of the ulcer is pathognomonic for an aphthous ulcer.
Recommended treatment is prednisone 40 mg/day plus hydrocodone in usual doses of 5/325, one or two tablets every 4 to 6 hours, as needed; topical petroleum jelly (especially before urination); and sitz baths. When the patient returns one week later, she is much improved.
For more information on this case, see “Chronic vulvar irritation, itching, and pain. What is the diagnosis?” OBG Manag. 2014;26(6):30-37.