Clinical Pearls

The most common cause of infectious vulvar ulcer disease in the United States is herpes simplex virus.

The classic outbreak is a painful cluster of vesicles and ulcers, although atypical lesions, such as abrasions or fissures, or no lesions can occur.

Acyclovir is indicated to suppress frequent recurrences during the year.

Primary herpes simplex virus is a systemic disease; recurrent herpes simplex virus is generally a local process.

Often, infected women complain of neurologic symptoms, such as tingling, burning, or itching at the skin site, before vesicles break out.


American College of Obstetricians and Gynecologists. Gynecologic herpes simplex virus infections. ACOG Practice Bulletin 57. Washington. DC: American College of Obstetricians and Gynecologists, 2004.

Droegemueller W. Infections of the lower genital tract. In: Stenchever MA, Droegemueller W, Herbst AL. Mishell DR, eds. Comprehensive gynecology. 4th ed. St. Louis: Mosby-Year Book. 2001:641-706.

McGregor JA, French JI. Lench JB. Pelvic infections: vulvovaginitis, sexually transmitted infections, and pelvic inflammatory disease. In: Hacker NF. Moore JG. Gambone JC, eds. Essentials of obstetrics and gynecology, 4th ed. Philadelphia: Saunders. 2004:296-308.

A 24-year-old G1 PI woman underwent a low-transverse cesarean section 2 days ago for arrest of active phase of labor. She required oxytocin and an intrauterine pressure catheter. Her baby weighed 8 lb 9 oz. The past medical and surgical histories were unremarkable. She denies a cough or dysuria. On examination, her blood pressure 120/70, heart rate 80 bpm, respiratory rate 12/min, and temperature 102°F. The breasts are nontender. The lungs are clear to auscultation. There is no costovertebral angle tenderness. Abdomen examination reveals that the skin incision is without erythema. The uterine fundus is firm, at the level of the umbilicus, and somewhat tender. No lower extremity cords are palpated.

^ What is the most likely diagnosis?

♦ What is the most likely etiology of the condition?

♦ What is the best therapy for the condition?

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