A 22-year-old woman comes to the emergency department with dysuria, vulvar pain, and pruritus. The patient has also felt feverish and fatigued for the last few days. She has a new sexual partner and has been using a hormonal vaginal ring for contraception. Physical examination reveals bilateral inguinal lymphadenopathy and tender vesicular lesions covering the labia majora and perineum. Which of the following conditions will most likely result as a sequela of this patient's infection?

Question

A 22-year-old woman comes to the emergency department with dysuria, vulvar pain, and pruritus.  The patient has also felt feverish and fatigued for the last few days.  She has a new sexual partner and has been using a hormonal vaginal ring for contraception.  Physical examination reveals bilateral inguinal lymphadenopathy and tender vesicular lesions covering the labia majora and perineum.  Which of the following conditions will most likely result as a sequela of this patient's infection?

Quizplus · Accepted Answer

11ec160b_37f4_9662_9249_431866cafaac_MD0001_00 This patient with tender, vesicular genital lesions and systemic symptoms (eg, fever, fatigue) likely has a primary genital herpes infection. Patients typically develop a characteristic genital rash consisting of small, grouped vesicles that progress into ulcers with crusting; the lesions may be pruritic and associated with painful inguinal lymphadenopathy. Genital herpes is caused by herpes simplex virus (HSV) type 1 or 2; patients exposed to one serotype can acquire the other. HSV can lie dormant in the sacral dorsal root ganglia and then reactivate; as a result, patients develop recurrent genital lesions. Recurrence is more common with HSV-2, and tends to be localized (no systemic symptoms) or asymptomatic (thereby increasing the risk for inadvertent transmission). Barrier contraception use decreases transmission. (Choice A) Fluctuant lymphadenitis (pus-filled inguinal buboes) can occur 1-2 weeks after Haemophilus ducreyi infection (ie, chancroid). Chancroid presents with multiple, painful genital ulcers and painful lymphadenopathy, but the lesions are typically deep with a gray exudate. Systemic symptoms are uncommon. (Choice B) Untreated syphilis (Treponema pallidum infection) can infect the dorsal roots of the spinal column and lead to tertiary neurosyphilis, which may be characterized by tabes dorsales (locomotor ataxia) and general paresis. Unlike primary genital herpes, primary syphilis typically presents with a painless genital ulcer with a clean base (chancre). (Choice C) Varicella-zoster virus also invades the dorsal root sensory ganglia, and reactivation causes herpes zoster (shingles). One complication is postherpetic neuralgia (persistent pain after resolution of herpes zoster lesions). Patients typically have a painful vesicular rash in a dermatomal distribution and no systemic involvement. (Choice E) Human papillomavirus (HPV) infection increases the risk of cervical and vulvar carcinoma. Certain strains (HPV 6 and 11) can cause anogenital warts (condylomata acuminata), which are pink or skin-colored papules or verrucous lesions, not ulcers. In addition, primary HPV infections do not cause fever or painful lymphadenopathy. Educational objective: Primary genital herpes (herpes simplex virus type 1 or 2 infection) presents as multiple, grouped vesicles on the genitals that progress to ulcers. Primary infections can cause systemic symptoms (eg, fever, malaise) and painful inguinal lymphadenopathy. Because HSV can invade and lie latent in the sacral dorsal root ganglia, patients are at risk for viral reactivation and recurrent genital lesions. __________ References: Current concepts for genital herpes simplex virus infection: diagnostics and pathogenesis of genital tract shedding. (http://www.ncbi.nlm.nih.gov/pubmed/26561565)

A 22-Year-Old Woman Comes to the Emergency Department with Dysuria