[Question #4051] UTI vs Herpes vs Bacterial STD

30 months ago
My girlfriend has been having issues with symptoms that appear to be consistent with a chronic case of cystitis (to my untrained eye)

- every 10 days or so she goes through a phase lasting circa 4-5 days of painful / urgency to urinate, as well as it being too painful to have sex. It does appear as if it is triggered by sex but it has also come on without sexual activity taking place. She hasn't had any other obvious symptoms to note. This has been going on for circa 9 months. 

I don't have any reason to believe that it is anything other than a chronic UTI, however I wondered what your view was on the differential diagnosis in this instance and what the available evidence points towards? 
Edward W. Hook M.D.
Edward W. Hook M.D.
30 months ago
Welcome to the Forum.  I'll be glad to comment.  If this problem has been recurring every week or two for nine months and is undiagnosed, the chance that it an STI is very, very small, close to zero.  If she has been seen by a health care provider during this period who performed a sexual health evaluation on her (recommended testing including for chlamydia, examination, etc.) then the small chance I mention falls to essentially zero.  As many persons with recurring symptoms worry about herpes, and just in case you are, nothing about this is suggestive of genital herpes.  Chronic cystitis in the differential diagnosis.  My advice to her is to see a trained women's health care specialist (i.e. a GYN) at the time she is having symptoms.  If scheduling is a problem she may need to be seen when she can get an appointment but my bias is that being seen at the time she is symptomatic may be most helpful.

Finally, one more word of warning.  Problems of this sort can be notoriously difficult to sort out, she may be seen by the doctor repeatedly to do this. going from doctor to doctor may be tough as with each new health care provider, that person should start her/his evaluation anew.

I hope this perspective is helpful.  I see no indication from what you describe to suggest that this is an STI. EWH
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29 months ago
Can an STI create the symptoms I’ve outlined?? I think what you’re saying is that it’s unlikely to be the case? 
Edward W. Hook M.D.
Edward W. Hook M.D.
29 months ago
Yes, I am saying that her symptoms are unlikely to be related to an STI.  It would be most unusual ( and unheard of in my experience) for STI symptoms to be cyclic.  EWH---