IDIOPATHIC GENITAL ULCERS IN WOMEN INFECTED WITH HUMAN-IMMUNODEFICIENCY-VIRUS

A national survey of investigators caring for human immunodeficiency v irus (HIV)-infected women was undertaken to describe the clinical pres entation of idiopathic genital ulcer disease. Patients with negative s yphilis and herpes simplex testing and/or negative genital ulcer biops y were included in this study. Study participants (n = 29) were genera lly severely immunocompromised (median CD4 cell count was 50/mm(3), an d 68% had an acquired immunodeficiency syndrome [AIDS]-defining opport unistic process). Thirty-seven percent had coexistent oral ulcers and 19% had their genital ulcer progress to fistula formation (four rectov aginal and one vaginal-perineal). There was generally a favorable resp onse to topical, systemic, and intralesional steroid treatment. This s tudy suggests that idiopathic or probable aphthous genital ulcers in w omen have similar clinical characteristics to aphthous oroesophageal u lcers. Although infrequent, these genital ulcers can cause severe morb idity. Further research is warranted to better define the pathophysiol ogy and optimal management.