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A Clinical and Microbiological Study

David Farhi, MD; Jeanne Wendling, MD; Emmanuel Molinari, MD; Jacqueline Raynal, MD; Guislaine Carcelain, MD; Patrice Morand, MD; Marie-Françoise Avril, MD; Camille Francès, MD; Flore Rozenberg, MD; Monique Pelisse, MD; Nicolas Dupin, MD, PhD

Arch Dermatol. 2009;145(1):38-45.

Objective  To describe the clinical and microbiological features of acute genital ulcers (AGU), which have been reported in virgin adolescents, predominantly in girls.

Design  Descriptive study. We collected data on the clinical features, sexual history, blood cell count, biochemistry, microbiological workup, and 1-year follow-up.

Setting  Departments of dermatology of 3 university hospitals in Paris.

Patients  Thirteen immunocompetent female patients with a first flare of non–sexually transmitted AGU.

Main Outcome Measures  Clinical and microbiological data, using a standardized form.

Results  Mean age was 16.6 years (range, 11-19 years). Eleven patients denied previous sexual contact. A fever or flulike symptoms preceded AGU in 10 of the 13 patients (77%), with a mean delay of 3.8 days before the AGU onset (range, 0-10 days). The genital ulcers were bilateral in 10 patients. The final diagnosis was Epstein-Barr virus primary infection in 4 patients (31%) and Behçet disease in 1 patient (8%). No other infectious agents were detected in this series.

Conclusions  We recommend serologic testing for Epstein-Barr virus with IgM antibodies to viral capsid antigens in non–sexually related AGU in immunocompetent patients. Further microbiological studies are required to identify other causative agents.

Author Affiliations: Service de Dermatologie, Pavillon Tarnier, Hôpital Cochin (Drs Farhi, Wendling, Avril, Pelisse, and Dupin), and Service de Virologie, Hôpital Saint-Vincent de Paul (Dr Rozenberg), Assistance Publique–Hôpitaux de Paris (AP-HP), Faculté de Médecine, Université René Descartes–Paris V, Paris, France; Service de Dermatologie, Hôpital Tenon (Drs Molinari and Francès), and Service d’Immunologie, Hôpital de la Pitié–Salpêtrière (Dr Carcelain), AP-HP, Faculté de Médecine, Université Pierre et Marie Curie–Paris VI, Paris, France; Service de Gynécologie, Centre Jean Perrin et Maternité, Hôtel Dieu, Clermont-Ferrand, France (Dr Raynal); and Service de Virologie, CHU de Grenoble, Faculté de Médecine, Grenoble, France (Dr Morand). Dr Wendling is now with the Service de Dermatologie, Hôpital d’Argenteuil, Bobigny, France.

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