Background Tuberculosis is a very common disease worldwide. In 2010 there were 71000 cases reported in Brazil. The genital presentation has a prevalence of 8–10 million cases worldwide. The vulvar/vaginal involvement is less than 2% of the cases. The clinical presentation can be variable and genital ulcers(GU) can be confused with sexually transmitted diseases(STD) such as syphilis and chancroid.
Methods/results(case report) MJS, 73y, G9P9, rural worker, attended at a clinic specialised in genital infections at the State University of Campinas-(UNICAMP)-Brazil with dysuria and pain/burning in the vulva for 3months. Physical examination revealed ulceration of 3cm in small genital right lip with bilateral inguinal painless adenopathy. The ulcer biopsy showed chronic granulomatous inflammation and search for AFB and fungi by techniques of Gomori and Ziehl-Nielssen were negative. Vaginal bacterioscopy and serologies were regular. Vaginal wall biopsy with search and culture resulted positive for complex M.tuberculosis. The Mantoux test resulted in strong reaction-13mm and the AFB sputum (3samples) was negative. Chest radiography showed no abnormalities. It was introduced the treatment with isoniazid+rifampicin for 6months. After 60 days the pacient presented ulcer resolution.
Conclusion The authors describe an unusual presentation of the disease, a painless chronic ulcer, for which differential diagnosis of GU by STD should be clarified. The isolation of M.tuberculosis in the culture of the ulcer is the gold standard for the diagnosis of genital tuberculosis. The ulcers caused by herpes virus, syphilis or chancroid are common, but it is essential to think of an infection by M.tuberculosis, especially in countries where the prevalence of the disease is high. It was suggested that the sputum of a subject with pulmonary tuberculosis when used as a lubricant during intercourse can transmit genital disease, making it an eventual STD. Chronic GU should be biopsied and the possibility of unusual etiologies should be considered.
- genital ulcer
- sexually transmitted disease