[Question #40] sti

40 months ago
Hello Dr. Handsfield,
Here is my situation. Late October 2014 I started to feel really itchy in my vagina and vulva all together and anus. I felt like ants were crawling from anus to vagina. I also felt shooting pain down my left leg. Then in November 2014 I started to have stinging pain in clitoris, labia majora and mons pubis. I developed 2 rigid, itchy bumps on mons pubis. When I popped them clear fluid came out of them. They were painful when I tried to squeeze the fluid, but were not painful when left alone. It took multiple weeks for those pubs to heal. The stinging pain and itchiness has still persisted until this day, on vagina and vulva. It has been decreasing with time but it's  still here. I also have vaginal odor. It was more severe last summer but it's still present. I also seem to have red lines coming out from vaginal opening moving up towards labia minora. When I itch they are more prevalent. When I don't itch, not so much. I have been tested for chlamydia, gonorrhea and HIV, all negative. They did a Pap smear but it came back normal. I ordered the IGG type specific test for Herpes 1 and 2 from herpselect but came back negative. I think it missed my infection. Can you please give me your opinion on my situation? I have been so depressed these 8-9 months :(. Btw I need to mention that in May 2015 I developed many little bumps on my bottom (where we sit on). They were not painful just itchy. It took weeks for them to heal and now they have like gray-brownish marks on the place where they were. Can you tell me what this might be? Herpes, HPV, trich? Or all of them combined?:(
Thanks for your help.
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
40 months ago
Welcome to Ask the Expert and thanks for your question. I'll try to help.

FYI, Terri Warren -- who as you know answer questions here as well as her own forum -- told me she replied to these questions on her own forum. She sent me her reply, but I haven't read it, to guarantee our replies are independent. But my guess is there won't be major differences. 

I'm confident you don't have herpes or any other STD. (Although vaginal odor suggests bacterial vaginosis, which may or may not be an STD -- more about which below.)

Although various websites refer to genital itching, irritation, etc as herpes symptoms, those sources often don't make clear that it's herpes lesions that itch or burn; those symptoms without open sores rarely are due to herpes. In addition, it sounds like you have had more or less continuous symptoms, which argues strongly against herpes. Herpes symptoms are always intermittent. Outbreaks occur no more often than once a month, and rarely that often -- typically every 2-4 months for HSV2 and yearly (or less) for HSV1. And between outbreaks there are no symptoms at all. There are virtually no exceptions -- and I think you'll agree this pattern doesn't fit your symptoms. Adding that to your negative blood test resuls and you can be sure herpes isn't the problem. (In fact, even if your blood test had been positive for HSV1 or 2, I would have advised that you have asymptomatic herpes -- genital or oral -- plus some other cause of your genital symptoms.)

As for other STDs -- well, there just aren't any that cause symptoms like this. The red bumps most likely were folliculitis, i.e. hair follicle inflammation or infection. For the itching and "ants crawling" sensation, my bet is on some variation of idiopathic vulvodynia. The fancy name doesn't really say much -- it's just Latin for vulvar pain of unknown cause. I really have nothing to say about the "white bumps" of the buttocks, or the various red streaks, marks, etc. You don't say whether you have seen a doctor about any of this -- but if they haven't seen anything abnormal (or if you haven't been examined), I have to suspect you're just noticing minor variations in normal genital tissues.

Which brings us back to vaginal odor. By far the most common cause is bacterial vaginosis, especially if the odor is fishy and/or more prominent after unprotected sex. BV is associated with some of the same things that predict STDs (new partner, multiple partners, etc) but nothing is found in male partners and treating them makes no difference in women's symptoms. So it's a bit of a mystery. But BV doesn't cause the other problems we have discussed, so this is likely an entirely separate problem.

My advice is that you find a gynecologist who specializes (or at least has special interest) in infectious diseases. In the meantime, as I said at the outset, I don't think this is an STD problem  of any kind, and for sure it isn't herpes. I hope at least that part of this opinion is reassuring, even if the rest of it remains a mystery. Sorry I can't be of greater help.

Best wishes--  HHH, MD
---
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
40 months ago
Now I've read Terri's reply on the Westover clinic forum. We're in exact agreement in regard to herpes -- she even said, as I did, that if your HSV blood test had been positive, it still wouldn't explained your symptoms. She mentioned yeast, which I neglected to do. I agree that's something to consider. Yeast can be hard to document even with careful exam and testing by an expert, and it may be worth trying an OTC yeast treatment (ny product with active ingredient ending in "azole").---
40 months ago
Thank you Dr. Handsfield for your reply.
I am a little bit more relaxed that two experts agree on the same thing, I am just really scared it's an STD. I have had sex only with one guy (unprotected, and he was my bf at the time) and I've been fingered two and half times. I know my bf had unprotected sex with his long term gf, whom she was a virgin when they were dating. He also had sex with another girl before her but I am not aware of her status nor do I know whether they used protection. He was received oral sex from another girl when we were broken up for a while. I have only seen a nurse practitioner and she also mentioned that the bumps on the mons pubis were foliculitis and for the bumps on the bottom she said they didn't look like herpes. Do you think I should order the western blot just to make sure for herpes? I haven't had any oral lesions but in 2008 after kissing a guy the next morning I developed like open cut where the upper and lower lip meet. It didn't look like oral herpes, it was just burning a little bit. It disappeared after two-three days. In 2011 the same thing appeared on the same spot on my lip. Never developed like a typical oral lesion, it just looked like an open cut. Does this suggest oral herpes? Those are the only two times I have had that appear on my lips. So far at least. As far as the odor, it began summer 2014. I haven't been sexually active since 2011. I know my odor is really prevalent after working out, although I can still smell it whenever I use the restroom. I haven't done test for HPV (the one that cause warts and cancer) but I will do that after this summer. I have only had a Pap smear done, but I know the Pap doesn't say whether I have HPV or not, it just shows if there are abnormal cells. Is that correct? 
Thanks so much again for the help.
40 months ago
The thing that I am most concerned about is that I feel like I may have herpes I just can't seem to recognize it from the other symptoms that I am experiencing. Because the bumps on my mons pubis were itchy, and painful when touched and I assume that could be an indication of herpes? And the stinging pain that I'm also experiencing pretty much every day.  Also I looked up online about the cut on my mouth that I've had before and it really resembles angular cheilits, although I may have that one wrong. But they do look alike. Also doesn't trich cause itchiness and foul discharge? I don't know how to tell the difference between trich or BV.
Thanks again for your help. I appreciate it.
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
40 months ago
It is obvious you are obsessed -- and I mean that as a clinical diagnosis -- with herpes or other STDs. But you describe an exceedingly low risk situation. 1) One lifetime sex partner and you have an STD? 2) That partner at very low risk, based on your description. He sounds like the average single guy at lower than average chance of having herpes or other STD. 3) Symptoms that don't fit with any known STD, including herpes (read my previous reply). 4) Negative testing for all STDs, including herpes. I could buy the rare exception to any one of these factors. But the statistical chance that all four have gone the wrong way for you, and that you have genital herpes is astronomical -- zero for all practical purposes. Your chance of being hit by a meteorite probably is higher.

BV doesn't cause stinging or itching, but could be the cause of the odor. So could trichomonas. There is no way for you to know the difference between them, but your doctor can easily figure it out. If you haven't been tested with a modern DNA test for trich, it's something to discuss with your doctor. And also discuss BV and a possible round of treatment for it. The treatment for BV would also treat trich if you happen to have it. 

Many (maybe most) of your symptoms may have a psychological origin, i.e. your anxieties about all this are making you abnormally sensitive to minor symptoms or even normal body sensations you otherwise would ignore or not even notice. I'm not saying the symptoms aren't real, and certainly if you end up having idiopathic vulvodynia, that's a physiologic problem that could explain everything. But for sure you don't have herpes and probably no other STD. Don't assume that just because the symptoms are genital and you've had sex that an STD must be the cause. There are entire textbooks about genital dermatology and other symptoms, and 95% of the conditions aren't STDs.

I truly hope these perspectives have helped. But for that to be true, you're going to have to accept the basic logic and scientific evidence I've tried to give you, as well as the professional reassurance from me, Terri, and (I'm guessing) the doctor(s) you have seen about all this. Good luck with it.
---
40 months ago
Thank you for your reply.I appreciate it. This is my last question for now, I promise.
I was reading online and it said that tumors on vulva or vagina or cysts can cause vulvodynia. I do have a lump beneath the vaginal opening on the right side. I need to pull the skin down from the vaginal opening and stretch the labia minora in order to notice it. It's kind of hiding but when I stretch the skin I can see it. It's dark red in color and it stings a little bit when I touch it. It's also moist a little bit and soft to touch. I don't have it on the left side. Could this be a wart or tumor?
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
40 months ago
At your age, there is simply no chance you have genital cancer. As for "tumors on vulva or vagina or cysts can cause vulvodynia":  no way! You need to stop searching the internet. Like many anxious persons, you are "seeing" those things that inflame your anxieties and missing the more accurate information that would be reassuring. You're just looking too hard, both online and in self examination. Stop examining yourself -- people don't do that! If you remain concerned, show it to a doctor. But truly, you are seriously overracting to all this. I hope you will seek professional counseling. I suggest it from compassion, not criticism. Good luck and best wishes.---