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------------------------------------------------ A 22-year-old architecture major comes to your office, complaining of severe burning with urination, a fever of 101 degrees, and aching all over. She denies any upper respiratory, gastrointestinal, cardiac, or pulmonary symptoms. Her past medical history consists of severe acne. She is currently on an oral contraceptive and has had no pregnancies or surgeries. She reports one new partner within the last month.

On examination, you observe a young woman appearing slightly ill. Her temperature is 100.3°F, and her pulse and blood pressure are unremarkable. Her head, ears, eyes, nose, throat, cardiac, pulmonary, and abdominal examinations are unremarkable. Palpation of the inguinal nodes shows lymphadenopathy bilaterally. Visualization of the perineum reveals more than 10 shallow ulcers along each side of the vulva. Speculum and bimanual examination are unremarkable for findings, although she is very tender at the introitus. Urinalysis shows some white blood cells but no red blood cells or bacteria. Her urine pregnancy test is negative.

Which disorder of the vulva is most likely in this case?

A) Genital herpes
B) Condylomata acuminata
C) Syphilitic chancre
D) Epidermoid cyst

The symptoms and findings such as multiple vulvar ulcers, fever, aching, and lymphadenopathies in a sexually active patient suggest the disorder is most likely Genital Herpes (option A).

The patient's symptoms and examination findings, such as painful urination, fever, body aches, numerous vulvar ulcers, lack of vaginal findings but extreme tenderness at the introitus, lymphadenopathies, and the presence of white cells in the urine, are highly suggestive of Genital Herpes. Condylomata acuminata (HPV infection) often yields genital warts rather than ulcers. Syphilis usually presents a single chancre, not multiple, and Epidermoid cysts do not cause systemic symptoms. Therefore, the presence of multiple tender, shallow ulcers, fever, and aching all over in a sexually active patient implies Genital Herpes is the most likely diagnosis.

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