Use of colposcopy in a patient with recurrent genital ulcers.

The patient was a 40-year-old female with a 5-month history of recurrent painful labial ulcers in December 2013. Investigations by a private physician revealed a negative VDRL (Venereal Disease Research Laboratory) test and vulval swab culture grew commensals only. The ulcers, however, failed to heal following treatment with antibiotics. Vulval biopsy was performed at her first visit and histopathology report revealed only a non-specific ulcer with negative stains for fungus, bacteria, acid-fast bacilli, and herpes simplex virus. Papanicolaou smear showed atypical squamous cells of unknown significance (ASCUS). In the absence of any obvious pathology for the non-healing ulcer, colposcopy was arranged: four ulcers were identified within the vagina, scattered over the right and left vaginal walls (Fig 1). A left lower vulval ulcer measuring 3 cm with slightly raised edges was also seen (Fig 2). Biopsies were taken over the cervix, vaginal, and vulval ulcers. Histopathology of these biopsies confirmed the presence of cervicitis and ulcers, with no evidence of malignancy. Upon systemic review, the patient revealed that she had been suffering from recurrent mouth ulcers and bruising over both shins. Subsequent examination revealed multiple aphthous mouth ulcers, as well as erythema nodosum over both shins. Based on the clinical signs, a diagnosis of Behcet’s disease was made. The patient was commenced on prednisolone, and all ulcers had healed at subsequent follow-up.