High School

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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. She has had no pregnancies or surgeries. She reports one new partner within the last month. On examination, you see a young woman appearing slightly ill. Her temperature is 100.3, 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. On visualization of the perineum, there are 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. Urine analysis has 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?

Answer :

Final answer:

The disorder of the vulva that is most likely in this case is herpes simplex virus infection. Symptoms include severe burning with urination, fever, aching all over, lymphadenopathy, and shallow ulcers along the vulva.

Explanation:

The disorder of the vulva that is most likely in this case is herpes simplex virus infection. The symptoms described, such as severe burning with urination, fever, aching all over, lymphadenopathy, and the presence of shallow ulcers along the vulva, are consistent with a herpes simplex virus infection.

Herpes simplex virus (HSV) infection can be caused by either HSV-1 or HSV-2. In this case, since the patient reports a new sexual partner, it is more likely to be caused by HSV-2, which is typically associated with genital herpes. Genital herpes is a sexually transmitted infection that can cause painful ulcers or sores on or around the genital area.

To confirm the diagnosis, a viral culture or polymerase chain reaction (PCR) test can be performed on a sample from the ulcers. Treatment typically involves antiviral medications, such as acyclovir or valacyclovir, to reduce symptoms and prevent recurrent outbreaks.

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