Primary Epstein-Barr virus infection presenting with genitourinary symptoms in a sexually active adolescent

Primary infection with Epstein-Barr virus (EBV) manifests with symptoms of sore throat, fevers, fatigue, and cervical lymphadenopathy. We identified no case reports in the literature of primary EBV infection presenting with genitourinary symptoms, although epidemiologic data suggest that it could be sexually transmitted.

A young, sexually active Canadian woman with recent travel to Central America presented for medical attention with pain on urination, acute painful inguinal lymphadenopathy, rectal pain, and elevated liver enzymes. She was assessed by consultants in Gynecology and Infectious Diseases. She had laboratory and diagnostic imaging to investigate for sexually transmitted diseases and acute hepatitis. A gynecological examination and pelvic ultrasound found no evidence of pelvic inflammatory disease. She tested negative for urinary tract infection and for common sexually transmitted infections including gonorrhea, chlamydia, HIV, syphilis, cytomegalovirus, toxoplasmosis, and hepatitis A, B, and C. We documented a positive heterophile antibody test for mononucleosis, significant vaginal viral shedding of Epstein-Barr virus (EBV)-DNA, and EBV seroconversion indicative of primary EBV infection. Symptoms slowly resolved over 4-12 weeks.

This case presentation demonstrates genitourinary symptoms as an initial clinical manifestation of primary EBV infection and suggests that EBV may be sexually acquired.