Your 22 year old female patient is c/o severe burning with urination, fever of 101, and aching all over. She takes oral contraceptives. She reports one new partner within the last month. Palpation of the inguinal nodes reveals bilateral lymphadenopathy. There are more than 10 shallow ulcers along each side of the vulva. She is very tender at the introitus. Urine has some WBCs but no RBCs or bacteria. Which disorder of the vulva is most likely?
Correct Answer: A
Rationale: The correct answer is A: Genital herpes. The patient's symptoms of severe burning with urination, fever, aching, new sexual partner, bilateral lymphadenopathy, multiple shallow ulcers along the vulva, tenderness at the introitus, and absence of RBCs or bacteria in urine are all consistent with genital herpes. Genital herpes is caused by the herpes simplex virus (HSV) and presents with painful vesicular lesions in the genital area. The presence of ulcers and lymphadenopathy points towards an infectious etiology. Condylomata acuminata (choice B) presents as genital warts caused by HPV, which typically do not cause ulcers. Syphilitic chancre (choice C) presents as a painless ulcer with a firm base, not multiple ulcers. Epidermoid cyst (choice D) presents as a benign skin lesion, not with the symptoms described.