Dear Doctor:

I am a 42 year old female dealing with chronic yeast infections (confirmed via culture from my physician's office) and have just been put on a 6-month Diflucan regimen. Before I get into my symptoms, a brief medical history:

1) Tested negative for all STDs in Jan 2013 when I started dating my now ex-spouse. This included HIV, HSV2, Hepatitis, Gon/Chlamydia, Syphilis and a normal/negative ( for HPV) Pap.

2) Tested  negative again in 2015 (routine testing done in relation to a pregnancy)

3) Roughly 2 months after my divorce was finalized in 2016 (October), I repeated all the above testing with negative/normal  results. I did not have any suspicions at that time, I simply wanted to have it on file as I entered the dating world. Figured it was easier to request it of someone if I had something to show myself.

Since the October testing, I've had one sexual encounter with someone I went out on a handful of dates with. This was late Dec of 2016. Even though I had no intention of sleeping with him and told him so, I did ask about his "status" prior to the encounter. He indicated he had recently been tested for HIV (negative) and had no other symptoms to speak of.  The encounter consisted of mutual masturbation,  (I believe it is referred to as ) brief nude "frottage", and he performed cunnilingus on me.  I did not reciprocate the oral and we did not have any penetrative sex whatsoever. I can attest to no visible issues with the penis as well (no sores, no discharge, etc.).  Normally, this encounter would have passed without another thought from me to be honest, if it weren't for the symptoms I've been experiencing the past few months.

A few days after this encounter, I visited my GP and was put the first of 2 rounds of antibiotics for a sinus/double ear infection. I had a z-pak and when the infection did not resolve, I was put on a round of Doxy ( if memory serves).  Not surprisingly, in January, I developed a yeast infection and treated both with OTC monistat and an oral diflucan. All seemed to resolve, but the yeast infection returned 2 weeks later. I'm now in the first part of Feb. I visited my Gyno and she cultured for yeast. It was confirmed and she gave me an Rx vaginal medication to try. Again, it seemed to work and I was symptom-free for about a month and a half.  In mid-April, I seemed to get yet another yeast infection but I was traveling so I was unable to get a culture. I called my Gyno so she called in 2 diflucan pills. Even after treatment, I continued to have external irritation and burning. So, last week,  I booked another appointment with my Gyno and she repeated the yeast culture as well as tested for Gon/Chlamydia/BV/Trich and at my request, HIV and diabetes. I also had a pap smear.  All negative/normal--except the yeast. This was not surprising given my overall lack of sexual activity since I had been tested in October. She also typed the yeast to make sure that it was susceptible to Diflucan (it was), and because she felt that I am  having some residual inflammation and irritation of the vulvar skin from chronic infections and gave me clobetasol cream along with this "6 month diflucan regimine).  

After doing my research, I became concerned that I may be experiencing 1) an atypical presentation of HSV 2,  2) an autoimmune issue of the vulvar skin  or 3) some sort of VIN. I called my doctor to discuss all 3 of those. In terms of HSV 2, she said she is not concerned for that based on my negative result the last 3 times I'd tested and the nature of my December encounter (one encounter, no sexual intercourse) wasn't really sufficient for transmission even if he'd had HSV 2 (and more likely that he didn't).  This confuses me, because I thought HSV 2 can be transmitted just from skin to skin contact. She also said she did not ever observe any lesions, sores, etc. during my multiple exams and that she did look externally and internally ( I even pointed out to her a specific area that would sting when I put a tampon in and she said there was "nothing at all there").

Can you offer some insight into my risk of contracting HSV 2 from the December encounter I described above? I'm very worried because I read a lot of women say they had herpes and they "just thought it was a yeast infection."

In terms of the autoimmune issues or the VIN, my doctor said she could take a biopsy if I wanted it. From your experience, should I be concerned with either of those scenarios? I'm becoming a bit desperate because I am in pain daily.-- just a general feeling of irritation and burning with redness and mild swelling. The discharge is sometimes white and clumpy, like you would expect. But sometimes it looks "normal" --just more of it. I have even had some spotting in it from time to time, but my doctor said it was because my cervix was irritated due to the inflammation.

Any thoughts you could provide would be greatly appreciated. I am committed to trying this 6 month program but I want to make sure I am not overlooking something more serious.

Thank you,

Caitie

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