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Vulvitis due to specific infections

(1) Virus infections

(a) Condylomata acuminata (viral warts). These soft pink or whiti papillomata may occur on any part of the vulva. They consist of numero fme frond-like processes. The warts vary in size from 1 mm to about 2 c and rarely the whole vulva may be obscured by them. They may extend u into the vagina. Sometimes there is severe irritation.

Although infection with Trichomonas vaginalis is often found, this coincidental and the possibility of other sexually transmitted infectio must also be considered. The condylomata are caused by a human papillom virus (HVP 6) which is usually transmitted by sexual contact, with incubation period of several weeks. The male partner may have or m develop penile warts. Condylomata may enlarge and spread during pr nancy. The virus cannot be cultured by the techniques which are ordin

available.

The warts have the structure of papillomata; a central core of connecti tissue with blood vessels is covered with a thick epidermal layer consis . of an overgrowth of the prickle cells. Electron microscopy shows

these cells are filled with virus particles. The best treatment is to remove the warts with cutting diathe under general anaesthesia. The resulting small burns are uncomfortable require frequent bathing and simple antiseptic dressings to prevent infecti When there are very few warts the excision can be done under 1 anaesthesia. They can also be treated by cryosurgery or with a laser. A coincidental vaginal discharge must be investigated and treated. There' tendency for the warts to recur, and more than one session of treatm may be needed. Any male contacts should be followed up.

Warts can also be treated by application of 20 per cent podophyllin benzoin tincture. This is a painful and not very effective treatment.

(b) Herpes genitalis. This viral infection is transmitted venereally. [ described on p. 140.

( c) Molluscum contagiosum is caused by a pox virus which is transmi by body contact or towels or clothing. Pearly-white umbilicated nod can occur anywhere on the skin. They are treated by application of phe to the centre of each papule. Diathermy or cryosurgery can also be u

(2) Bacterial infections

(a) Ozancroid (soft sore). This is caused by Ducrey's bacillus, which transmitted sexually. Multiple painful shallow ulcers occur on the vu1 There is inguinal adenitis and secondary infection generally occurs' the formation of a bubo (abscess) in the groin (see p. 141).

(b) Gono"hoea. Gonococci do not invade the vulval skin, but cause infection of Skene's tubules at the lower end of the urethra. Th may also cause a Bartholin's abscess, although this lesion is more comma due to other organisms.

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