Vulval Ulcer | Lecture Note

University:
The University Of Western Ontario
Course:
ANAT 2200B | Systemic Anatomy of the Human Body
Academic year:

2022
Views:

250

Pages:

6
Author:

Kyuwon J.

Vulval Ulcer ● Break in Vular Epithelium ○ Pain and burning sensation ○ Discharge and bleeding ● Infection ○ STI ● Non-infectious ○ Inflammatory ○ Autoimmune ○ Drug reactions ○ Trauma ○ Malignancy High-yield differentials ● Infectious ○ Common ○ Exam relevant ○ HSV-1 and HSV-2 ■ Common for genital ulcers - painful ■ Prodrom ● Tingling and burning ● Cluster of vesicles ● Shallow and painful ulcers ● Inguinal nodes ● Dysuria possible ○ Syphilis ■ Treponema pallidum ■ Classically single and painless ■ Indurated ulcer ■ Non-tender nodes ■ Atypical is also possible if it is superinfected ○ Chancroids ■ Less common ■ Painful ● Soft ragging ulcer ● Painful unilateral and bilateral suppurative nods ● Buboes ○ LGV ■ Chlamydia trachomatis ■ L1-L3 ■ Red ■ Friable painless ulcers ■ Uncommon ○ Other types of infections ■ Aphthous-type vulvar ulcers ● Adolescents ● Young adults ● Viral illness ● Acute and painful necrotic ulcer ○ Bilateral kissing lesion is also possible in some case ● Dx after STI workup ■ Behçet disease ● Recurrent oral ● Genital ulcer (recurrent) ● Involving eyes ● Pathergy ■ Inflammatory dermatoses ● Lichen planus ○ Erosive ○ Painful ○ Scarring ● Lichen sclerosus ○ Pruitus ○ Thin skin as paper ○ Fissure and erosion on skins Amsel criteria ● Need at least 3 of 4 ○ Homogenous, with thin and white/grey discharges ○ Coats vaginal walls ○ Milky ○ Uniform no clumps ● Vaginal pH above 4.5 ○ This is taken from lateral vaginal wall fluid ■ It is to avoid cervical mucus and bleeding ■ Contamination avoidance is also an important factor ● Whiff test positive ○ 10% addition of KOH on vaginal fluids ■ Fishy amine odor ■ Odor stronger after intercourse ● During menses ● Clue cells on wet mount microscopy ○ Vaginal epithelial cells ■ Bacterial adherent to cell border ○ Fuzzy looking ○ Stippling edge ○ More than 20% epithelial cells tends to be clue cells BV ● Usually in minimal vulvovaginal inflammation ● Candidiasis as contrast ○ Erythema ○ Itch ● Trichomonas ○ Strawberry cervix ○ Frothy discharge ● Amsel ○ Clinical ○ Bedside ● Could use Nugent score instead of Amsel criteria ○ Gram stain scoring Tips ● D ○ Discharge ■ Thin ■ Homogenous ● P ○ pH>4.5 ■ If normal BV is less likely ■ Think of Candida ● W ○ Whiff + ● C ○ ¾ = BV ○ Epithelial cells ■ Obscuring on borders ■ Adherent coccobacilli ■ Taught as >20%