Vulvar shingles symptoms

Vulvar shingles symptoms DEFAULT

At a Glance - Genital herpes zoster vs herpes simplex


By Dr Jean Watkins on the 11 November 2010

Dr Jean Watkins discusses the differences between genital herpes zoster and herpes simplex

Herpes zoster presents with a rash

Genital herpes zoster

Aetiology

  • After chickenpox, the herpes zoster virus lies dormant in a sensory nerve ganglion.
  • If reactivated later, shingles presents in the affected dermatome.
  • More common in the elderly, immunosupressed and those with haematological malignancies.

Presentation

  • Unilateral pain (often severe) and itching in perineal area. May have fever.
  • A few days later, unilateral vesicular rash develops in the region of the affected nerve.
  • Dries, crusts and heals over the following few weeks.
  • Pain may persist for months, especially in the elderly (post herpetic neuralgia).
  • Risk of secondary infection and dysuria.

Management

  • Usually clinical diagnosis but viral swab can be taken for confirmation.
  • Antiviral therapy recommended for the over-sixties or if immunosupressed.
  • Treatment is aciclovir 800mg five times daily for seven days. More effective if started within 72 hours of rash onset.
  • Topical calamine lotion or wet dressings with 5% aluminium acetate.
  • Topical lidocaine for painful urination.
  • Analgesics for pain. If necessary add amitriptyline, gabapentin or topical capsaicin.

Herpes simplex presents with small painful blisters

Genital herpes simplex

Aetiology

  • Caused by the herpes simplex virus, usually type-2.
  • Usually sexually transmitted.
  • Following initial infection, the virus lies dormant but may reactivate.

Presentation

  • Itching, tingling and burning in the perineal area.
  • Groups of small painful blisters develop on the labia, vagina or cervix.
  • Risk of secondary infection, dysuria and retention of urine.
  • Risks in pregnancy include microcephaly, microphthalmia, intracranial calcifications or chorioretinitis.

Management

  • Diagnosis may be confirmed by viral swab of blister fluid.
  • Topical treatment as for herpes zoster.
  • Early treatment with an antiviral (aciclovir 200mg five times daily for five days) may settle the condition quicker.
  • Prophylactic antiviral therapy for frequent recurrences for up to six to 12 months.

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Sours: https://www.gponline.com/glance-genital-herpes-zoster-vs-herpes-simplex/sexual-health/sexual-health/article/1039186

Herpes and post-herpetic neuralgia

Genital herpes is a common sexually-transmitted infection caused by the Herpes Simplex Virus (HSV).  It often causes painful blisters that may occur in clusters on the vulva or around the anus.  There are two types of HSV.  In the past, HSV-1 was associated with cold sores of the mouth, lips, or eyes and HSV-2 was associated with genital lesions; however HSV-1 is becoming a more common cause of genital herpes, especially in young women.  The first outbreak may be associated with flu-like symptoms and may last between 2 to 4 weeks.  Recurrences of genital herpes are often signaled by burning, itching, or tingling before sores appear.  Recurrent outbreaks are typically less painful and heal more quickly. 

Post-herpetic neuralgia is painful condition that affects up to 10% of patients who have had herpes zoster (also known as Shingles), which can occur on the vulva.  Post-herpetic neuralgia describes continued pain after the rash goes away.  It is causes by damage to the nerves from the herpes virus.  Post-herpetic neuralgia may be an under-recognized cause of chronic vulvar pain, especially in older women.

Treatment

Herpes is managed with antiviral medications taken at first sign of an outbreak or to suppress or prevent future outbreaks.

Sours: http://vulvodynia.com/conditions/herpes-and-post-herpetic-neuralgia
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Vulval Problems

The vulva contains skin, mucous membrane and glands. There is enormous potential for pathology, including psychosomatic problems. The scope is so wide that this article aims to give just a general overview with frequent links to other articles that cover aspects in greater detail.

The vulva is affected by lack of oestrogen after the menopause. Pruritus vulvae and irritation are common symptoms in a postmenopausal woman. Examination of the vulva should exclude finding ulceration or a mass that may accompany these, as they may also be indicative of infection, inflammation, or malignancy.

Consider infective causes, dermatological conditions, hormonal deficiency, systemic disease and malignant or pre-malignant change. The likely spectrum of disease varies considerably according to the age of the patient.

Vaginismus and sexual dysfunction in women are covered elsewhere - see the separate Vaginismus article. As many as one fifth of women have significant vulval symptoms.

Presentation

Symptoms

Note first the age of the patient. Get as much history as possible before examination:

  • Are symptoms sudden or gradual in onset?
  • Is there pain, discomfort, irritation, or itching, or just 'something which has been found'? Dyspareunia has its own separate article.
  • Is there any discharge?
  • Is it a vulval or a vaginal problem? Many women are not very good at accurate localisation of that part of their anatomy.
  • Is there anything to see? Some women will have made close inspection with a hand mirror whilst others would not contemplate looking down there.
  • Is there dysuria? If so, is there urinary frequency too? There may be no urinary tract infection but it is painful to pass urine through an inflamed area.
  • If she is sexually active? Does her partner have any problems?
  • Are there any other current problems such as psoriasis, chickenpox or recent use of antibiotics?

Signs

Signs are as variable as the differential diagnosis and so they will be considered together. Generally, examination will be limited to inspection with gentle parting of the labia. Vaginal examination is often unnecessary and, with the current condition, it may be too painful to be reasonable.

Investigations

Some conditions can be diagnosed simply on inspection but others may require swabs and possibly viral culture or even biopsy to confirm the nature.

Congenital anomalies

Female genital abnormalities are uncommon and often do not present until, or well after, puberty. See the separate Female Genital Abnormalities article for more information.

Infections

Candidiasis

Candidal infection can occur at all ages.

  • It may cause vaginitis and a white, curdy discharge as well as vulvitis.
  • There is usually pruritus and a red rash.
  • Topical antifungal creams are usually adequate. Vaginal infection may need treating too.

Varicella

Girls with chickenpox sometimes get vesicles around the vulva. This can be very painful or itchy. Treatment is symptomatic with tepid baths, soothing lotions and occasionally topical anaesthetic creams.

Genital herpes

See the separate Genital Herpes Simplex article.

Genital herpes is caused equally in the UK by the herpes simplex viruses types 1 and 2 (HSV-1 and HSV-2) and it is spread by direct contact. There are painful, fluid-filled vesicles around the genital area. Virus can be cultured from the fluid.

  • All sexual contacts must be notified to seek advice. Ideally referral to a genitourinary medicine (GUM) clinic should be made for diagnosis, treatment and contact tracing.
  • The vesicles leave tender ulcers that may take two to four weeks to heal the first time they occur.
  • Typically, another outbreak can appear weeks or months after the first, but it is almost always less severe and is shorter than the first outbreak. Although the infection can lie dormant indefinitely, the number of outbreaks tends to decrease over a period of years.
  • Management involves salt baths, analgesics, loose underwear, antiviral therapy and abstinence from sexual intercourse until all ulcers are healed

Genital warts

Genital warts are caused by human papillomavirus (HPV), usually types 6 and 11.

  • Transmission is usually sexual.
  • Warts can appear one to eight months after infection.
  • There may be pain, bleeding and pruritus.
  • Screening for other sexually transmitted infections is usually advisable.
  • Podophyllin paint compound BP destroys the affected skin cells so the warts shrink or disappear. It must be applied accurately and should not be used in pregnancy.
  • Other treatments include imiquimod, cryotherapy and electrocautery.

Shingles

Herpes zoster does not often affect the genital region but the lesions are characteristic. The anterior two thirds of the labia majora are innervated from L1 and the posterior third from S2/S3/S4.

Infestations

Infestations such as scabies and pubic lice may affect the area. Treatment is with an insecticide such as malathion or permethrin. For pubic lice, screening for other sexually acquired infections is advised, and infected individuals should be advised to notify sexual partners. For scabies all household members should be treated simultaneously.

Dermatological conditions

Nappy rash

  • Nappy rash is an irritant contact dermatitis.
  • The skin in contact with nappies is exposed to friction and excessive hydration, has a higher pH than other skin, and is repeatedly soiled with faeces containing enzymes with high irritation potential for the skin[1].
  • The combination of these factors frequently results in skin damage, leading to visible erythematous lesions that can be irritating and painful to the child.
  • The vulva may be bright red and there may be little patches away from the main part, suggesting candidal infection too.
  • Note whether the child looks cared for or neglected.
  • Advise about frequent nappy changing and also leaving the child without a nappy for as long as possible.
  • Advise use of a barrier preparation at each nappy change[2].
  • Topical hydrocortisone 0.5-1% once a day for up to a week may be considered to reduce inflammation[3]. This should be applied sparingly, then followed a few minutes later by application of the barrier preparation.
  • If there is suspicion of candidal infection, a combination of hydrocortisone and an antifungal is required.
  • Consider oral antibiotics for secondary bacterial infection.

Vulval dermatitis

  • Dermatitis may be irritant (for example, from wetness, incontinence, vigorous cleansing) or allergic contact dermatitis. Specific allergic reactions (eg, to perfume or rubber) may cause pruritus vulvae. Patch testing may be useful.

Almost any skin disorder may also affect the vulva but a few are of special note:

  • Lichen planus has a very unpleasant variation that causes painful erosive vulvitis:
    • It usually affects women over the age of 45, and the vestibular area and lower vaginal skin can (rarely) be involved[4].
    • Examine the mouth which may also be involved.
    • There is intense erythema, oedema and superficial ulceration.
    • It leads to scarring and introital narrowing resembling chronic lichen sclerosus.
    • Biopsy will distinguish it from other ulcerative disorders, including pemphigus, pemphigoid and erythema multiforme.
    • Systemic steroids are often required.
  • Psoriasis is not usually itchy, but it can be on the vulva:
    • It does not affect the vaginal mucosa.
    • It may be necessary to take scrapings to exclude tineal infection.
    • There will usually be evidence of the disease elsewhere.
    • Treatment is as for psoriasis elsewhere.
  • Behçet's syndrome is a disease of unknown aetiology:
    • It is characterised by recurrent aphthous ulcers, possibly ulcers of the vulva. There is often associated uveitis.
    • These usually occur on a cyclical basis and often are related to the menstrual cycle.
    • They are sometimes associated with arthritis, usually of the knees.

Swelling

Swelling or oedema of the vulva can be due to venous or lymphatic obstruction:

  • Secondary to malignancy in the pelvis.
  • Dependent oedema with prolonged sitting in bed.
  • Pregnancy, where varicosities may appear - usually resolving at the end of the pregnancy.
  • Haematoma suggesting trauma (may have been of a sexual nature).

Vulval ulcers

When a patient presents with a vulval ulcer the following need to be excluded with culture and/or biopsy with colposcopy:

Sexually transmitted infection

Malignancy

Other ulcerative conditions

Potentially pre-malignant conditions

Lichen sclerosus

  • Most cases of lichen sclerosus are in postmenopausal women, although it can occur in prepubescent girls and young women. It can be familial and may affect the male prepuce too.
  • The risk of developing invasive disease is around 4%[5].
  • There is an association with other autoimmune diseases, usually a thyroid disorder.
  • Lichen sclerosus may present with pruritus vulvae, vulvodynia, superficial dyspareunia, or visible lesions. It has an appearance called 'cigarette paper' skin as it is thin, white and crinkly. The introitus may shrink with fusion of the labia minora.
  • Treatment is with potent topical corticosteroids.

Vulval intraepithelial neoplasia (VIN)

  • VIN is a pre-malignant condition which can arise in pre-existing vulval disorders, or independently.
  • It usually presents with pruritus. There may be red, white or raised areas of skin.
  • It is a histological condition and a biopsy must be taken.
  • Treatment is usually by local excision. Imiquimod can be effective as an alternative or adjunct to surgery.
  • Some women may not have active treatment.

Malignant disease of the vulva

85% of cancers of the vulva are squamous and the remaining are of various histological types, including melanomas. Vulval cancer may present with a vulval lump, vulval bleeding due to ulceration, pruritus or pain. See the separate Vulval Cancer and Vulval Intraepithelial Neoplasia article for further information.

Paget's disease of the vulva[6]

  • Extra-mammary Paget's disease is a rare form of superficial skin cancer. However, the most common site of involvement is the vulva.
  • It is seen mainly in postmenopausal white women.
  • A woman with Paget's disease of the vulva may present with pruritus and weeping or bleeding of the lesion.
  • The lesion appears to have an eczematous or velvet-like surface.
  • Surgical excision is the gold-standard treatment; however, recurrence rates are high and extensive excisions can produce long-lasting cosmetic and functional defects.
  • There is increasing evidence for the safety and efficacy of 5% imiquimod[7].
  • Other treatments include photodynamic therapy, laser therapy, radiotherapy or chemotherapy.

Melanoma

  • Melanoma should be considered if there are pigmented lesions on the vulva.
  • They are suspicious if they are blue-black in colour, have a jagged or fuzzy border, are raised or ulcerated, or are larger than approximately 1 cm.
  • Melanomas may be misdiagnosed as undifferentiated squamous carcinoma, particularly if they are amelanotic.
  • Most melanomas are located on the labia minora or clitoris and prognosis is related to the size of the lesion and the depth of invasion.

Referral

Consider a suspected cancer pathway referral (for an appointment within two weeks) for vulval cancer in women with an unexplained vulval lump, ulceration or bleeding[8].

  • When a woman presents with vulval symptoms, a vulval examination should be offered.
  • Vulval cancer can also present with vulval bleeding due to ulceration. A patient with these features should be referred urgently.
  • A patient who presents with pruritus or pain may be reasonably managed with a period of 'treat, watch and wait'.
  • This should include active follow-up until symptoms resolve or a diagnosis is confirmed.
  • If symptoms persist, the referral may be urgent or non-urgent, depending on the symptoms and the degree of concern about cancer.
  • Other paths of referral may include a GUM clinic or gynaecology or dermatology, based on appearance and suspicions of the examining GP.

Sexual abuse

See the separate articles Safeguarding Children - How to Recognise Abuse or a Child at Risk and Safeguarding Children - Referral and Management of an Abused or At-risk Child for detailed information.

Sexual abuse can occur at any age (including in the elderly) but the problem is particularly well documented in children.

If a child presents with a condition that is usually sexually transmitted (such as genital warts or HSV), sexual activity needs to be considered, but it is not the only cause. Evidence of trauma, especially with a spurious explanation, is also suggestive. Other features may include behavioural disorders and inappropriate sexuality of behaviour.

  1. Stamatas GN, Tierney NK; Diaper dermatitis: etiology, manifestations, prevention, and management. Pediatr Dermatol. 2014 Jan-Feb31(1):1-7. doi: 10.1111/pde.12245. Epub 2013 Nov 14.

  2. Shin HT; Diagnosis and management of diaper dermatitis. Pediatr Clin North Am. 2014 Apr61(2):367-82. doi: 10.1016/j.pcl.2013.11.009. Epub 2014 Jan 14.

  3. Lawton S; Nappy rash: diagnosis and treatment. J Fam Health Care. 2014 Jul-Aug24(5):36-40.

  4. Regauer S, Reich O, Eberz B; Vulvar cancers in women with vulvar lichen planus: A clinicopathological study. J Am Acad Dermatol. 2014 Jul 3. pii: S0190-9622(14)01546-1. doi: 10.1016/j.jaad.2014.05.057.

  5. Green C, Guest J, Ngu W; Long-term follow-up of women with genital lichen sclerosus. Menopause Int. 2013 Feb 15.

  6. Edey KA, Allan E, Murdoch JB, et al; Interventions for the treatment of Paget's disease of the vulva. Cochrane Database Syst Rev. 2019 Jun 56:CD009245. doi: 10.1002/14651858.CD009245.pub3.

  7. Sanderson P, Innamaa A, Palmer J, et al; Imiquimod therapy for extramammary Paget's disease of the vulva: a viable non-surgical alternative. J Obstet Gynaecol. 2013 Jul33(5):479-83. doi: 10.3109/01443615.2013.790348.

  8. Suspected cancer: recognition and referral; NICE guideline (2015 - last updated January 2021)

Sours: https://patient.info/doctor/vulval-problems-pro
Shingles: Pathophysiology, Symptoms, 3 stages of Infection, Complications, Management, Animation.

What Is Shingles? Symptoms, Causes, Diagnosis, Treatment, and Prevention

The varicella zoster virus — the virus that causes chickenpox and shingles — is part of a group of viruses called herpes viruses. This group also includes the viruses that cause cold sores (oral herpes) and genital herpes.

But the varicella zoster virus is not the same virus that causes cold sores and genital herpes. The viruses that cause oral and genital herpes are herpes simplex 1 and herpes simplex 2.

If you’ve had chickenpox, you can get shingles. After the chickenpox is over, varicella zoster lies inactive, mainly in spinal or cranial nerves. Sometimes the virus reactivates, and that’s when it travels along the nerves to erupt as a rash on your skin, causing shingles.

But the cause of the reactivation is still unknown, according to the National Institute of Neurological Disorders and Stroke.

Risk Factors

The risk of shingles increases as you age, which may be due to lowered immunity to infections as you grow older.

The following may also put you at increased risk for shingles, according to the CDC.
  • Certain cancers, such as leukemia and lymphoma
  • HIV or AIDS
  • Immunosuppressive medications, such as corticosteroids, which are used in the treatment of cancer and autoimmune conditions like rheumatoid arthritis, as well as drugs that are given to people who have undergone an organ transplant
Some research suggests that genetics may play a part, according to MedlinePlus.If you have a first-degree relative — meaning a parent or sibling — who has had shingles, it may increase your risk of having it. A study published in the Journal of Clinical Virologyfound that nearly 44 percent of those with shingles had family members who had also developed it.

Is Stress a Risk Factor for Shingles?

You may have heard that someone got shingles because they were stressed, perhaps after the death of a relative, soon after a divorce, or at the end of a difficult semester at school.

But studies haven’t definitively proved that stress is a risk factor for shingles. Some research suggests that it is, according to MedlinePlus, while other research suggests that it’s not at all.
In a study published in March 2015 in Clinical Infectious Diseases, researchers reviewed the medical records of more than 39,000 people to see if cases of shingles increased after a difficult life event, and the authors found no evidence that stress is a trigger.

“There’s some controversy about the matter,” says Safdieh. “We know for a fact that stress can have an impact on the function of the immune system. If there’s stress, immunity is depressed, and I certainly see patients who tell me they were having a lot of stress when they got shingles.” But, he adds, “there are many people who are stressed and don’t get shingles, and many people who get them while they’re on vacation.”

If there is a link between stress and shingles, it’s probably not that the stress itself is putting a strain on the immune system — it may be that stress creates conditions that lower immunity. “Keep in mind,” says Safdieh, “that when you’re stressed, you don’t sleep and you don’t eat, and all these factors can play a role.”

RELATED: How Stress Affects Your Body, From Your Brain to Your Digestive System

Sours: https://www.everydayhealth.com/shingles/guide/

Shingles symptoms vulvar

10 Causes of Vulvar Ulcers and How to Treat Them

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What are vulvar ulcers?

The vulva is the outer part of a woman’s genitals. Vulvar ulcers are sores that appear in this area. Vulvar ulcers can be extremely painful and, in some cases, they may not hurt at all.

Most of the time these lesions are caused by sexually transmitted infections (STIs) but many other issues can trigger an ulcer. There are several effective treatment options for these sores.

Read on to learn more about what causes vulvar ulcers and how to treat them.

Symptoms

Vulvar ulcers might start out looking like bumps or a rash. Or, the sores might appear as breaks in your skin that expose tissue.

Symptoms of vulvar ulcers vary, but may include:

  • pain or discomfort
  • itchiness
  • leaky fluid or discharge
  • painful or difficult urination
  • enlarged lymph nodes
  • fever

Sometimes, vulvar ulcers don’t cause any symptoms.

Types of vulvar ulcers

Generally, vulvar ulcers are classified as being sexually acquired or nonsexually acquired.

A sexually acquired vulvar ulcer means the lesion is the result of sexual contact. This is the most common type of genital ulcer.

Nonsexually acquired ulcers are also called acute genital ulcers. These are more common in young women who aren’t sexually active.

Possible causes

There are many possible reasons vulvar ulcers develop, including:

1. STIs

The most common cause of genital ulcers in the United States is the herpes simplex virus (HSV), followed by syphilis. Other STIs can lead to ulcers, including:

Additionally, some women with HIV may develop ulcers on their genitals.

STIs are more common that you might think. According to the American Sexual Health Association, 1 in 2 people who are sexually active will contract an STI by age 25.

2. Fungal infections

Vulvovaginal candidiasis, also known as vaginal yeast infection, is the most common fungal infection that causes vulvar ulcers or erosions. Other symptoms of yeast infections include:

  • burning during sex and urination
  • itching
  • increased vaginal discharge

3. Viral infections

Certain viruses can cause vulvar ulcers to form:

  • Epstein-Barr virus
  • cytomegalovirus
  • varicella zoster, the virus that causes chickenpox and shingles

4. Bacterial infections

Infections caused by bacteria, such as Group A Streptococcus and mycoplasma, can trigger sores on the vulva. Bacterial infections are usually treated with antibiotics.

5. Inflammatory diseases

Several types of inflammatory and autoimmune diseases can cause lesions to form around the vulva. Depending on how severe these are, they may appear like ulcerations. Some of these include:

6. Trauma

Chronic rubbing or scratching of the vulva can lead to skin irritation and ulcers.

7. Other illnesses

Sometimes, common conditions like tonsillitis, upper respiratory infections, or a virus that causes diarrhea can cause genital ulcers, especially in adolescent girls.

8. Drug reactions

Medicines like nonsteroidal anti-inflammatory drugs (NSAIDs), sulfonamides, and certain antibiotics can cause a reaction that triggers ulcers.

9. Cancer

Vulvar cancer can cause ulcerlike lesions around the vagina. This type of cancer is more common in older women.

10. Skin reactions

Sometimes, a bad reaction to skin care products can cause a genital ulcer. You might want to switch to soaps and lotions for sensitive skin if this happens.

Incidence

Worldwide, about 20 million people develop some type of genital ulcer condition each year.

HSV types 1 and 2 are the most common causes of genital ulcers in the United States. 1 in 5 women and 1 in 9 men ages 14 to 49 has genital HSV type 2 infection.

What tests are used to diagnose the cause of vulvar ulcers?

Your doctor will probably perform a physical exam and explore your health history to determine what’s causing your vulvar ulcers. You might be asked about your sex life, number of sexual partners, and what medications you take.

Additionally, your physician will need to look at the ulcer or ulcers to get a better idea as to what could be causing them.

Your doctor may recommend one or more of the following tests:

You may also need a biopsy. A biopsy is a procedure that involves removing a sample of the ulcer and sending it to a lab for further examination.

Treatment

Your treatment approach will depend on what’s causing your ulcers. Some vulvar ulcers may go away on their own, but others will require prompt therapy so they don’t lead to infection.

Your doctor might recommend several types of therapies to treat your condition.

STIs are typically treated with antibiotic and antiviral medicines, given as either a pill or a shot.

Vulvar ulcers that aren’t caused by infections may be treated with:

  • corticosteroids
  • antihistamines
  • immunomodulatory drugs, such as methotrexate

Your healthcare provider might show you how to effectively clean your ulcer until it heals. You might also need special dressings to cover and protect the area.

Sometimes, home remedies may be used to relieve the pain and discomfort of vulvar ulcers. Popular methods include:

  • Epsom salt baths
  • oral pain relievers, such as acetaminophen (Tylenol)
  • cool compresses to the affected area
  • topical anesthetics, such as lidocaine
  • barrier ointments, such as petroleum and zinc oxide
  • avoiding irritants, such as harsh soaps, douches, or tight-fitting clothing

Shop for epsom salt, acetaminophen, topical anesthetics, and petroleum jelly.

Complications of vulvar ulcers

If vulvar ulcers are left untreated, they may lead to complications.

In some cases, scarring, adhesions, infection, and inflammation can occur in or around your genitals. Additionally, untreated ulcers can lead to continued pain and emotional stress.

If you have an untreated STI, you’re at risk of contracting another one. You can also spread the infection to others. Some STIs can cause serious issues. For example, untreated syphilis nervous system and heart problems. And if you become pregnant, an STI can affect the fetus.

Outlook

Many STIs can be cured or managed with proper treatment. Other causes of ulcers may be helped with the right therapies.

You might be able to prevent or lower your risk of a vulvar ulcer by practicing safe sex and getting tested for STIs regularly.

If your vulvar ulcer is caused by another medical condition, such as an inflammatory or autoimmune disease, you may be referred to a specialist who can help treat your condition.

Although vulvar ulcers might elicit embarrassment, you should see your doctor right away if you develop them. You don’t have to live with the pain, discomfort, and distress that these lesions commonly cause.

Sours: https://www.healthline.com/health/womens-health/ulcers-vulva
Shingles - Causes, Symptoms and Treatments: What everyone needs to know.

Shingles may be behind vulvar pain

Clinicians should be aware of genital shingles as a potential, underlying cause of chronic vulvar pain, say researchers. They highlight two such cases in the latest issue of Obstetrics and Gynecology.

Dr. Anne Louise Oaklander (Massachusetts General Hospital, USA) and colleagues describe the cases of two women who endured years of chronic pain before a correct diagnosis of vulvar shingles was made.

Shingles, which is caused by the varicella zoster virus, can have severe effects on the skin and nervous system, and may become a debilitating condition if left untreated, note the researchers.

In one of their case reports, Oaklander et al describe a 35-year-old woman whose chronic vulvar pain was caused by shingles, who was misdiagnosed and treated inappropriately for 6 years.

While vulvar shingles affects an estimated 1.5 million American women, it is often missed during gynecological examinations, according to the researchers.

"Although less than 10 percent of cases affect the genitals, shingles is such a common disease that all clinicians who perform routine gynecologic examinations should expect to encounter and treat it," conclude the researchers.

This is particularly important, as, once diagnosed, shingles is highly treatable with antiviral medication and tricyclic antidepressants, they add.

Sours: https://www.medwirenews.com/gynaecology/shingles-may-be-behind-vulvar-pain/227602

Similar news:

Postherpetic neuralgia after shingles: an under-recognized cause of chronic vulvar pain

Background: Vulvar shingles, an uncommon presentation of a common disease, probably affects 1.5 million American women during their lifetime and leaves about 150,000 with postherpetic neuralgia, a chronic neuropathic pain syndrome. Prompt diagnosis and treatment can minimize pain severity and duration.

Cases: The case of an 88-year-old woman with sacral shingles is described. Complications led to her demise. A 35-year-old with a 6-year history of disabling vulvar pain and many diagnostic procedures was ultimately diagnosed with postherpetic neuralgia.

Conclusion: Shingles needs to be included in the differential diagnosis of vulvar rashes because it is a modifiable risk factor for chronic vulvar pain. The possibility of postherpetic neuralgia must be considered in women with unexplained vulvar dysesthesia.

Sours: https://pubmed.ncbi.nlm.nih.gov/12039124/


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