Non-Infectious Acute Genital Ulcers in Females: Clinical Characteristics and Association with Systemic Diseases

Abstract

Background: Genital ulcers exhibit a wide range of clinical symptoms influenced by both infectious and non-infectious factors, necessitating precise differential diagnosis. Non-infectious causes, including Behçet’s disease, Crohn’s disease, and Lipschütz ulcers, present diagnostic challenges due to their diverse manifestations and potential association with systemic diseases.

Objective: To analyze the clinical characteristics of non-infectious acute genital ulcers in females and explore their association with systemic diseases, aiming to enhance the differential diagnosis process and contribute to the development of clinical guidelines.

Methods: A retrospective study at Severance Hospital involved 12 female patients with sudden-onset of deep genital ulcers, recorded from January 2015 to December 2022. Data included age of the onset, history of genital and oral ulcers, symptoms, polymerase chain reaction for sexually transmitted diseases, serology for Epstein-Barr virus (EBV), Cytomegalovirus (CMV), Herpes simplex virus (HSV), and HLA-B51 testing.

Results: The average age of onset for genital ulcers was 27.6 years. All patients experienced oral ulcers. Serology for EBV, CMV, and HSV showed predominantly negative results. Recurrence of genital ulcers was observed in five patients, with three of these patients diagnosed with systemic diseases: one with Crohn’s disease, one with typical Behçet’s disease, and one with gastrointestinal Behçet’s disease.

Conclusion: Our study highlights the intricacy of diagnosing non-infectious genital ulcers in females, emphasizing the need for a comprehensive diagnostic approach to consider a range of etiologies. The association with systemic diseases in certain cases underscores the importance of a broad diagnostic perspective, especially in recurrent or atypical presentations.