A case of labial adhesions following primary genital herpes infection

Abstract

INTRODUCTION: Genital Herpes is one of the common sexually transmitted diseases in Sri Lanka. Although, the labial adhesions usually associated with hypo-oestrogenism, it may occur as a rare complication of Genital Herpes infection. Here we present a case of almost complete thick band labial adhesions following Genital Herpes infection. Case Report: A 23 year old nulliparous woman presented with vulval pain, dysuria and fever for two days. On vulval examination she had extensive, multiple, painful genital ulcers with some blistering lesions over both labia majora and minora. She had been in a monogamous relationship with the partner, with last sexual exposure about 10 days prior to the development of ulcers. Presumptive diagnosis of primary genital herpes was made on clinical manifestations. She was treated with 7 days course of oral Acyclovir. Ten days later she presented with a complaint of narrowing of the vaginal introitus and dysuria. On examination vulval lesions were in the partial remission and there was thick band of adhesion on the upper two third of labia minora with multiple scars of healing ulcers on either side. Manual separation of adhesions was not attempted due to tense nature of the adhesions. Surgical separation of labial adhesions was done under general anesthesia. After two weeks she made complete remission of Genital herpes ulcers and there were no further labial adhesions. A further follow up appointment was arranged in three months. DISCUSSION: Labial adhesions are not common among women in reproductive age who are having well oestrogenised vulva, in comparison to prepubertal and postmenopausal women with less oestrogenised vulva. Labial adhesions are rare, but severe form of local complication of genital herpes infection. The formation of labial adhesions can be prevented by early treatment with adequate dose of oral acyclovir. Gentle application of local anaesthetic over the labia minora alleviates pain and prevents labial adhesions formation in patients with genital herpes. The usual solution for adult labial adhesion following genital herpes infection is surgical adhesiolysis. Manual separation of the labia under application of local anaesthesia can be considered in patients who have less dense adhesions. This is the first published material in Sri Lanka on this matter. The importance of this report is to maintain the vigilance among health care providers about this rare complication as Genital Herpes infection is a very common sexually transmitted infection in Sri Lanka.