Understanding Stevens-Johnson Syndrome (SJS)

Stevens-Johnson syndrome (SJS) is a severe reaction to a medication which causes skin to blister and peel. SJS may also cause blisters on mucous membranes such as the vagina, mouth and urinary tract. If you are going to develop SJS, it’ll usually happen in the first two months of taking a new drug.

SJS is a medical emergency. Quick treatment is important so if you have these symptoms, seek emergency care. If you start taking a new drug and start to experience symptoms, seek help.

Symptoms of Stevens-Johnson syndrome

  • Fever
  • Flu-like symptoms
  • Painful red or purple burnt-looking skin
  • Blisters on the skin and in/on the genitals, mouth, nose
  • Painful, red, watery eyes

Causes of SJS

There are over 100 drugs that may cause SJS, however some of the most common include:

  • Allopurinol (Aloprim, Zyloprim) (gout treatment)
  • Acetaminophen (Tylenol, Panadol, Paracetomol)
  • Ibuprofen (Advil, Motrin, Nurofen)
  • Naproxen sodium (Aleve)
  • Sulfa antibiotics (Bactrim, Septra)
  • Carbamazepine (Carbatrol, Tegretol) (seizure or psychiatric drugs)
  • Infections like pneumonia or the herpes virus (cold sores, genital herpes)
  • Some genes you inherit from your parents (particularly those of Asian descent), poor immunity or radiation treatments might leave you more susceptible

Treatments for SJS

You will usually require hospital care for 2-4 weeks by a specialist team in the intensive care unit or burns centre. The suspect medication will be stopped. You will be monitored and treated for your symptoms, kept hydrated, and your blisters will be kept clean and dressed as necessary to stop infections.

You may require a feeding tube, since your mouth and digestive tract may be blistered, making eating very painful to impossible.

Recovery takes time and proper care.

SJS vaginal and urogenital issues

The urogenital impacts of SJS can pose serious quality of life issues for those affected. Labial adhesions, urinary tract symptoms and painful sex can all be consequences.​1​

Vaginal symptoms can take time to heal. Symptoms may appear in the vagina first, and include including erosive and ulcerative vaginitis, vulvar blisters, and vaginal adhesions, with painful sex, post-sex bleeding and narrowing of the vaginal entrance.​2​

The stream of urine may be obstructed, resulting in urine being retained in the bladder resulting in recurrent cystitis/urinary tract infections, dribbling urine, and menstrual blood getting held up in the uterus or vagina, sometimes causing endometriosis.

One case report includes a woman treated with sulfa antibiotics for a UTI, which caused vaginal symptoms. She was treated again for those symptoms and ended up with much worse symptoms, and a diagnosis of SJS​3​.

References

  1. 1.
    Byun JM, Jeong DH, Kim YN, Lee KB, Sung MS, Kim KT. Labial adhesions caused by Stevens–Johnson syndrome. Dermatologica Sinica. Published online December 2015:239-240. doi:10.1016/j.dsi.2015.02.004
  2. 2.
    Kaser D, Reichman D, Laufer M. Prevention of vulvovaginal sequelae in stevens-johnson syndrome and toxic epidermal necrolysis. Rev Obstet Gynecol. 2011;4(2):81-85. https://www.ncbi.nlm.nih.gov/pubmed/22102931
  3. 3.
    Mergler R, Chuang M. Stevens Johnson Syndrome with Vaginal Pain and Lesions as Initial Presentation. Am J Case Rep. Published online December 21, 2018:1519-1521. doi:10.12659/ajcr.912123


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Jessica Lloyd - Vulvovaginal Specialist Naturopathic Practitioner, BHSc(N)

Jessica is a degree-qualified naturopath (BHSc) specialising in vulvovaginal health and disease, based in Melbourne, Australia.

Jessica is the owner and lead naturopath of My Vagina, and is a member of the:

  • International Society for the Study of Vulvovaginal Disease (ISSVD)
  • International Society for the Study of Women's Sexual Health (ISSWSH)
  • National Vulvodynia Association (NVA) Australia
  • New Zealand Vulvovaginal Society (ANZVS)
  • Australian Traditional Medicine Society (ATMS)
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