Matak, Luka

Matak, Magdalena

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ACTA DERMATOVENEROLOGICA CROATICA199Unusual Case Presentation of Genital HerpesActa Dermatovenerol Croat                               2022;30(3):199-200                                         LETTER TO THE EDITORINTRODUCTIONGenital herpes is the most common sexually transmitted disease and is most commonly caused by herpes simplex virus -2 (HSV2) which is usually sexu-ally transmitted (1). We report a case of a 28-year-old woman with an unusual case of HSV presentation that rapidly resulted in necrosis and rupturing of the labia less than 48 hours after first appearance of symptoms.CASE PRESENTATIONWe report the case of a 28-year-old female patient who presented to our clinic with painful necrotic ulcers of both labia minora, urinary retention, and extreme discomfort (Figure 1). The patient reported unprotected sexual intercourse a few days prior to the pain and burning sensation and swelling of the vulva. A urinary catheter was inserted immediately due to intense burning and pain while urinating. The vagina and cervix were covered with ulcerated and crustal lesions. The Tzanck smear test showed multi-nucleated giant cells, and polymerase chain reaction (PCR) analyses were conclusive for HSV infection, while syphilis, hepatitis, and HIV tests were negative. Since there was progression of the labial necrosis and the patient became febrile two days after admission, we performed debridement twice under systemic an-esthesia, and the patient receive systemic antibiotic together with acyclovir. On the follow-up visit, four weeks later, both labia had epithelized completely.DISCUSSIONIn primary genital herpes, after a short incubation period, multiple bilaterally located papules, vesicles, painful ulcers, and crusts appear, which resolve over a period of 15 to 21 days (2). Clinically atypical pre-sentations include either unusual sites or atypical morphological forms of genital disease, exophytic (verrucoid or nodular) superficially ulcerated lesions, mostly seen in patients with HIV, fissures, localized recurrent erythema, nonhealing ulcers, and burning sensation in the vulva in a patient with lichen sclero-sus (1). This patient was discussed in our multidisci-plinary team, as we know that ulcerations could be associated with rare malignant vulvar pathology (3). The golden standard for diagnosis is PCR from the le-sion (1). Antiviral therapy should be initiated within 72 hours of primary infection and continued for 7 to 10 days. CONCLUSIONThe process of removing nonviable tissue is called debridement. Debridement is only necessary when a herpetic ulceration is not healing on its own, which is when necrotic tissue that can harbor bacteria that may cause more extensive infections is formed. Re-moving the necrotic tissue speeds up healing and re-duces the risk of further complications. Figure 1. Edematous and necrotic bilateral minor labia with linear rupture on the medial side of the right labia. ACTA DERMATOVENEROLOGICA CROATICA200Letter to the editor Acta Dermatovenerol Croat  2022;30(3):199-200Conflict of interest:The authors report no conflict of interest.References:1.  Gnann JW Jr, Whitley RJ. Clinical practice. Genital Herpes. N Engl J Med. 2016 Aug 18;375:666-74.2.  Corey L, Wald A. Genital herpes. In: Holmes KK, Sparling PF, Stamm WE, ed. Sexually transmitted diseases. 4th ed. New York: McGraw-Hill; 2008. pp. 399-4373.  Matak L, Dukić B, Tupek T, Lisica-Šikić N, Mikuš M. Primary ectopic lobular breast cancer of the vulva: case report and review of literature. J Obstet Gy-naecol. 2020;40:727-30.Magdalena Matak1, Luka Matak21Department of Dermatovenerology, General Hospital Zadar, Croatia 2Obstetrics and Gynecology specialist, Department of Obstetrics and Gynaecology, General Hospital Zadar, CroatiaCorresponding author: Luka Matak, MDDepartment of Obstetrics and GynecologyGeneral Hospital ZadarZadar, Croatia lmatak1011@gmail.comReceived: March 20, 2022Accepted: September 1, 2022

Unusual Case Presentation of Genital Herpes

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