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Mucosal ulcerative disorders in adolescent females can be caused by sexually transmitted as well as nonsexually transmitted diseases. In this chapter, common mucosal ulcerative disorders are discussed sequentially and include:

  1. Vulvar herpes simplex virus (HSV) infection

  2. Syphilis in teenage females

  3. Chancroid

  4. Behcet Disease

Vulvar Herpes Simplex

See Chapter 114, Herpes Simplex, for information on all types of herpes simplex infections.

Patient Story

A 16-year-old girl presents with vulvar swelling, pain, and difficulty urinating. She admits to being sexually active. On examination, ulcerative lesions are noted on the inner aspects of the labia minora (Figure 75-1). She is treated with analgesics and oral acyclovir for presumed Herpes simplex virus type 2 (HSV-2). She is also tested for other STDs including blood tests for syphilis, HIV, and urine tests for gonorrhea and chlamydia. Her culture of the lesions is positive for HSV-2 as expected. Her other tests are all negative. Her lesions resolve after 2 weeks.


Tender ulcerative lesions on the vulva which are positive for herpes simplex virus infection. (Used with permission from Centers for Disease Control/Susan Lindsley, MD.)


HSV-2 is a sexually transmitted infection that usually causes vesicles and ulcers in the genito-anal region. HSV-1 usually involves infections found extra-genitally. HSV-2 infections present with painful genital ulcerative lesions. HSV-1 can occur in the genito-anal region and HSV-2 can occur on the oral mucosa. There are many people with positive serologies for both types of herpes simplex that are not aware of having a “herpes infection” with symptoms.


  • The prevalence of HSV increases with age.14

  • By age 15 years of age, 40 percent will be infected with HSV-1.2

  • The prevalence of HSV-1 is greater than HSV-2 in most areas of the world and since HSV-2 is primarily sexually transmitted, it is not as common in children.

  • Data from the Centers for Disease Control and Prevention (CDC) monitored through the National Health and Nutrition Examination Survey (NAHNES) found the overall prevalence of HSV-2 from 2005 to 2008 to be 16.2 percent; of those testing positive for HSV-2 infection, 81.1 percent said they had never been told by a doctor or health care professional that they had genital herpes.2

  • In this study, seroprevalence increased with age, ranging from 1.4 percent among those aged 14 to 19 years to 26.1 percent among those aged 40 to 49 years.2

  • HSV-2 seroprevalence is greater among women (20.9%) than men (11.5%).2

Etiology and Pathophysiology

  • Genital herpes is usually caused by HSV-2 but may also be caused by HSV-1.

  • Transmission occurs more commonly from an infected male to a female partner.

  • Infection occurs ...

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