[Question #6711] Yeast or herpes

12 months ago
Hello!  I had sex with a new partner 10 days ago.  8 days ago I broke out in a rash in my entire genital area which was extremely itchy, which my dr swabbed for herpes.  This swab came back negative for hsv, though yeast did come back as positive.  In addition to yeast infection discharge, my dr. noted a smelly yellow colored discharge that they did not know what to make of.  I was put on fluconazole, and they said they also suspected I might have had some sort of allergic reaction but did not give me any medication for this.  Approximately two days after seeing the dr, I noticed two patches bilaterally on my outer labia that were almost perfectly symmetrical, approximately .5 inch in length and just looking kind of pink.  The other rash looked like a bunch of pinpoint dots with normal flesh colored skin between them, but this rash is kind of bumpy and raised and contained to one area.  I checked again yesterday and these two patches are still there, despite the yeast infection treatment.  They were stinging a little.  When I look VERY closely, I think I can see indented type bumps that maybe could be pin-head sized blisters?  And a very tiny scab.  It is very hard to see them as they are very small, and when I went to the dr. to have them swabbed both the dr and I were unable to find the patches.  Now at home I am able to see them clearly.  I am wondering how much this sounds like herpes?  Also I am unsure what to do moving forward for swabbing given that the dr. couldn't see them?  Does herpes often present in such a mild way for a primary outbreak? 
12 months ago
I forgot to include that the sex was with a condom and that I also tested neg for chlamydia, gonorrhea, B.V.
Terri Warren, RN, Nurse Practitioner
Terri Warren, RN, Nurse Practitioner
12 months ago
This actually doesn't sound like herpes to me with the very disseminated rash, negative herpes swab test, and positive yeast test.  The bumpy rash does sound fungal (yeast).  However, the description you gave of the bumps having an indentation is also interesting - there is an infection called molluscum contagiosum which presents with a flesh-colored bump with an indentation in the top.  I might be more concerned about this possible diagnosis except it sounds like it came up so quickly after the contact.  Usually, molluscum takes a bit longer to show up and they aren't usually pin-head sized - most often, larger.  If the bumps continue to be present, you could go back in a week or two and ask the doctor if the bumps could be molluscum.  Sometimes when people have symptoms that follow a concerning sexual encounter, they examine their genitals way more closely than they ever have before, so it is also possible, I supposed, that these could be normal for you and you've never noticed them before?  Just a thought.

On the good news side, condoms reduce transmission of HSV 2 by a whopping 96%, so that speaks against a herpes diagnosis as well.

If you develop any other type of skin lesion in the genital area, be sure to have it looked at again.  It's OK to go back more than once when you are still worried.

Terri


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12 months ago
Thanks for your response!  To clarify, the disseminated rash is not the rash I was worried about.  The disseminated rash was swabbed and was negative, and already to me and my doctors seemed very clearly not to be herpes.  My concern was this rash:

"I noticed two patches bilaterally on my outer labia that were almost perfectly symmetrical, approximately .5 inch in length and just looking kind of pink.  The other rash looked like a bunch of pinpoint dots with normal flesh colored skin between them, but this rash is kind of bumpy and raised and contained to one area.  I checked again yesterday and these two patches are still there, despite the yeast infection treatment.  They were stinging a little.  When I look VERY closely, I think I can see indented type bumps that maybe could be pin-head sized blisters?  And a very tiny scab." 

This was a different rash than the disseminate rash.  It seemed to have a erythematous base (I don't know if that's the right terminology, but I am trying to convey that it was a patch and not the same as the widespread dotted rash).  Also I have had molluscum before and this doesn't look like that, not waxy or flesh colored or anything.  I read somewhere that herpes blisters can collapse inward leaving a slight dimple which was why I was concerned.   They also definitely have not always been there, they are gone now after about a week, but it was very clearly not normal skin.

My other question is that I had sex a few days ago and my vagina swelled up immensely and was very painful.  I didn't have any more visible skin issues at this point- but could this be a result of some sort of residual interior herpes infection?  Or is this something that is seen in yeast?
12 months ago
Whoops sorry I missed the part where you said that the bumpy rash also sounded fungal.
Terri Warren, RN, Nurse Practitioner
Terri Warren, RN, Nurse Practitioner
11 months ago
It's possible that this was a herpes infection - so difficult to tell at this point, I'm afraid.  Now you are left to do an antibody test to sort out whether this could be herpes or not.  You should not do this any sooner than 6 weeks for a preliminary result and 12 weeks for a final result.  But again, since the contact was condom protected, herpes is quite unlikely.  I know this must be worrisome for you, with no definite answers, but that's my best guess as of now.

Terri
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