Indian J Sex Transm Dis Indian J Sex Transm Dis
Official Publication of the Indian Association for the Study of Sexually Transmitted Diseases
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CASE REPORT
Year : 2008  |  Volume : 29  |  Issue : 1  |  Page : 40-41
 

Vaginal discharge due to primary varicella


1 Department of Dermatology, Venereology and Leprology and Virology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
2 Department of Dermatology and Venereology, All India Institute of Medical Sciences, New Delhi, India

Correspondence Address:
Somesh Gupta
Department of Dermatology and Venereology, AIIMS, New Delhi-110 029
India
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Source of Support: None, Conflict of Interest: None


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   Abstract 

Cervicitis is an important cause of abnormal vaginal discharge. We describe a case of vaginal discharge due to cervicitis caused by primary varicella zoster infection in a patient with chronic immunosuppression. Though a few reports of genital infection due to chicken pox are available, to the best of our knowledge, there are no reports of abnormal vaginal discharge due to cervicitis caused by chicken pox.


Keywords: Cervicitis, chicken pox, vaginal discharge, varicella zoster virus


How to cite this article:
Ajith C, Gupta S, Ratho RK, Narang T. Vaginal discharge due to primary varicella. Indian J Sex Transm Dis 2008;29:40-1

How to cite this URL:
Ajith C, Gupta S, Ratho RK, Narang T. Vaginal discharge due to primary varicella. Indian J Sex Transm Dis [serial online] 2008 [cited 2019 Oct 22];29:40-1. Available from: http://www.ijstd.org/text.asp?2008/29/1/40/42716



   Introduction Top


Abnormal vaginal discharge (AVD) is one of the commonest presenting symptoms in sexually transmitted diseases clinics. The symptoms and signs of AVD can be due to pathology in the vagina, the uterus, or the cervix. Various features of the vaginal discharge, such as amount, odor, color, consistency, pH of the vaginal secretions, and associated inflammation / symptoms related to vulval or vaginal epithelium, depend on the etiologic factor(s). [1] Infections causing vaginitis and cervicitis are the commonest cause of vaginal discharge. [1],[2] Various agents that commonly cause cervicitis include  Neisseria More Details gonorrhoeae, Chlamydia trachomatis, Trichomonas vaginalis , herpes simplex virus, etc. [3] We describe a case of vaginal discharge secondary to cervicitis due to varicella zoster virus (VZV) infection.


   Case Report Top


A 42-year-old female patient presented with fever, multiple vesicular lesions, and vaginal discharge of 2 days' duration. She had undergone renal transplant 16 months ago for chronic glomerulonephritis and was on immunosuppressive drugs, including cyclosporine, prednisolone, and azathioprine. She developed fever initially, followed by the appearance of multiple, discrete vesicular lesions over the trunk, which later spread to involve the face and proximal extremities. She also noticed profuse vaginal discharge associated with a burning discomfort during micturition. On examination, there were multiple discrete vesicular lesions on an erythematous base over the face, trunk, and extremities [Figure 1]. There were no lesions in the oral cavity. Multiple discrete vesicular lesions were also present on the inner aspects of the labia majora and labia minora [Figure 2]. Per speculum examination showed a mucoid discharge in the vagina. However, the vaginal wall was free of any lesions. The cervix was congested and covered with multiple papulovesicular lesions, but there were no frank erosions [Figure 3]. There was no discharge from the cervical os. The ruptured eroded vesicular lesions were the only source of the discharge.

Tzanck smear from the skin lesion and from the cervix showed the presence of multinucleated giant cells. Baseline serology for varicella zoster virus (VZV) IgM and herpes simplex virus (HSV) IgM antibody was negative; however, subsequent serology for VZV IgM done 7 days later was positive, whereas HSV IgM remained negative. The patient was diagnosed as having varicella and was treated initially with oral acyclovir 800 mg five times daily. Within 24 h she presented with an attack of generalized tonic-clonic seizures. Suspecting CNS involvement secondary to varicella, she was started on intravenous acyclovir at a dose of 10 mg/kg every 8 h, which was continued for 10 days. Other investigations like complete blood count, liver and renal function tests, blood sugar level, electrocardiography, and roentgenogram of the chest were normal. Computed tomography scan of head and cerebrospinal fluid analysis were also within normal limits. She recovered completely within 1 week, with clearance of the cervical and labial lesions and scabbing of the cutaneous lesions. The vaginal discharge subsided completely by the fifth day of therapy.


   Discussion Top


Of the various viral causes for vaginal discharge due to cervicitis, herpes simplex infection of the cervix is the commonest. [4] Chicken pox is a common infection seen in young though it can affect all age-groups. Oral mucosal involvement can occur and commonly presents as discrete oral mucosal erosions; however, involvement of other mucosal sites, especially of genital mucosa, has not been reported frequently. In our case, the skin lesions were typical of chicken pox; however, the vesicles on the inner labia and those on the cervix initially made us consider the possibility of disseminated herpes infection, especially in view of the underlying immunosuppressed state. The negative HSV (paired) serology ruled out herpes simplex infection, whereas VZV serology became positive, confirming the clinical diagnosis. It is well known that VZV IgM serology may take a few days to become positive. [5] Also, the immunosuppressed state of the patient might have prevented an early mounting of an adequate immune response.

Herpes zoster of the genitalia is well known and one study has shown that 3% of presumed genital herpes are in fact due to VZV. [6] Primary varicella infection of the genitalia in both pediatric and adult populations has also been described. [7],[8] To the best of our knowledge, no literature is available of primary VZV infection (chicken pox) involving the cervix and producing a vaginal discharge. We suggest that chicken pox be added to the list of the causes of vaginal discharge, especially in patients with chronic immunosuppression.

 
   References Top

1.Mitchell H. Vaginal discharge-causes, diagnosis and treatment. BMJ 2004;328:1306-8.  Back to cited text no. 1  [PUBMED]  [FULLTEXT]
2.Quan M. Vaginitis: Meeting the clinical challenge. Clin Cornerstone 2000;3:36-47.  Back to cited text no. 2    
3.Sweet RL. The enigmatic cervix. Dermatol Clin 1998;16:739-45.  Back to cited text no. 3  [PUBMED]  
4.Mertz GJ. Genital herpes simplex virus infections. Med Clin North Am 1990;74:1433-54.  Back to cited text no. 4  [PUBMED]  
5.Cohen PR. Tests for detecting herpes simplex virus and varicella zoster virus infections. Dermatol Clin 1994;12:51-68.  Back to cited text no. 5  [PUBMED]  
6.Birch CJ, Druce JD, Catton MC, MacGregor L, Read T. Detection of varicella zoster virus in genital specimens using multiplex polymerase chain reaction. Sex Transm Infect 2003;79:298-300.  Back to cited text no. 6  [PUBMED]  [FULLTEXT]
7.Simon HK, Steele DW. Varicella: Pediatric genital/rectal vesicular lesions of unclear origin. Ann Emerg Med 1995;25:111-4.  Back to cited text no. 7  [PUBMED]  [FULLTEXT]
8.Cass AS. Chicken pox in adult presenting as acute severe genital infection. Urology 1993;41:52-3.  Back to cited text no. 8    


    Figures

  [Figure 1], [Figure 2], [Figure 3]



 

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    Abstract
    Introduction
    Case Report
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    References
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