What Is This Woman’s Genital Lesion?

AUTHORS:
Nguyet-Cam V. Lam, MD, and Richa Sharma, MD
Family Medicine Residency, St. Luke’s University Hospital, Bethlehem, Pennsylvania

CITATION:
Lam N-CV, Sharma R. What is this woman’s genital lesion? Consultant. 2020;60(2):51-52. doi:10.25270/con.2020.02.00004

A 34-year-old woman with a medical history significant for allergic rhinitis, seasonal allergies, and childhood eczema presented with concern for a genital lesion of 2 days’ duration. The patient stated that she had felt a bumplike lesion in her perineum 2 days prior, which then had flattened. The lesion was painless and nonpruritic; however; she stated that urination caused irritation.

The woman had history of unprotected sex 2 months prior. She denied use of any new cosmetics, laundry detergent, or medication, but she had been swimming in community pool recently. She denied any vaginal discharge, pruritus, lower abdominal pain, recent fever, cough, cold, and rash elsewhere on her body. She had an intrauterine device (IUD) and had had a period 2 weeks ago.

On examination, the abdomen was soft and nontender, and no inguinal lymphadenopathy was noted. Two nontender, 2-mm ulcerative lesions with clear edges and a pale base were noted on the vulva. No induration of the lesions’ margins was present. One lesion was on the superior aspect inside the labia majora and the other on inside of the left labia inferiorly (Figure).

Speculum examination showed a multiparous cervix. Threads of IUD were visualized on examination. Bimanual examination demonstrated no cervical motion tenderness. The uterus was firm and nontender with no adnexal tenderness.

Two days later, the patient called reporting that she had developed multiple such lesions all over her vulva. The lesions were still painless but caused burning and irritation with urination.