Cervical ulcers may be caused by non-STDs, such as cervical cancer, serious vulvovaginal candidiasis, cervical tuberculosis, and Behcet’s syndrome. However, STDs, such as syphilis chancre and HSV2 infection, may also cause cervical ulcers. In this case, cervical biopsy under colposcopy showed the presence of inflammatory granulation tissues, thereby ruling out cervical ulcer caused by cervical cancer, syphilis, tuberculosis, herpes, and fungi or acute cervical inflammation caused by Chlamydia trachomatis and Mycoplasma hominis. Given that the cervical ulcer of this patient is rarely encountered in clinics, the possibility of Behcet’s syndrome should be considered in patients presenting these signs and symptoms.

Behcet’s syndrome is characterized by multiple tissue and organ damage caused by autoimmune disorders, with repeated attacks and remission. Oral cavity, eyes, genitals, and skin are the most frequent injury sites There is no specific serological and pathological characteristics. The diagnosis is mainly based on clinical symptoms and signs [5]. About 57-93% of patients with Behcet’s syndrome have genital ulcers, mainly in the vulva, but the cervix can also be affected. The lesion is similar with oral ulcers [6]. The diagnostic criteria of Behcet’s syndrome requires the presence of oral ulcerations plus any two of the following: genital ulceration, typical defined eye or skin lesions, or a positive pathergy test [7]. Our patient had clear vision, no visual deterioration, no history of recurrent oral ulcer, and no oral and skin ulcerations upon physical examination, therefore, Behcet’s syndrome could be ruled out. The patient’s cervical biopsy suggested that inflammatory cells in the tissues infiltrate and grow into new capillaries without cancerous cells. Vaginal discharge culture was positive for BV and had growth of GBS, which was the main causative bacteria of the cervical ulcer.

GBS is facultative anaerobic bacteria and is an opportunistic pathogen for pregnant women, newborns, and the elderly [8]. GBS exists in the vagina or lower digestive tract in 10-40% of women [9]. GBS infection can lead to intrauterine infection, abortion, premature delivery, premature rupture of membranes, and other adverse pregnancy outcomes, which cause severe adverse consequences, such as neonatal pneumonia, meningitis, and septicemia. Adult men and women can also have severe GBS infection, such as urinary tract infection, pneumonia, or soft tissue infection, which are the most common diseases in adults [10]. With the widespread use of antibiotics, research focusing on the drug resistance to GBS and drug sensitivity test in vitro in recent years showed that GBS had a high drug resistance to erythromycin and clindamycin [11]. Antibacterial drugs with no or low drug resistance included cephalosporins, penicillin, vancomycin, and so on [12]. Given that vancomycin has certain hepatorenal toxicity to the body, it is not recommended as the first drug choice. Although some cases with Streptococcus infection had drug resistance to penicillin, their drug resistance was relatively low. Therefore, penicillin can be used as the first choice in the treatment of GBS, and cephalosporin antibiotics can be used for patients allergic to penicillin. In our study, this patient had also BV. Metronidazole is the preferred drug for treating BV [13, 14]. Accordingly, the patient was orally administered 500-mg cefradine four times daily + 400-mg metronidazole twice daily for 7 days, and the cervical ulcer was successfully treated.

In conclusion, based on the screening of cervical cancer and STDs, cervical ulcers caused by non-STDs should be paid attention. Complete medical history and bacterial culture of cervical secretions can help identify the etiology of the disease and decide the appropriate targeted treatment.

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