I have been experiencing horrible vaginal symptoms for about 1 week. Hard to fully describe all that is happening. Is attaching a picture possible? Otherwise I'm not really sure you'll understand what I am describing. If it is not possible, can this question be closed and refunded? I'll do my best to get help but I've been to 3 urgent cares and nothing is working. 

Thanks so much. I really appreciate all that you guys do!

HHH, MD

Tuesday: vaginal pain begins. Its significant but tolerable. I feel a lot of pain in my groin lymph nodes.

Wednesday: vaginal pain worsens and I take a mirror and look. I see long vertical lacerations, like wide paper cuts all around my vaginal opening. Each lacerations about 2.5 inches long, very red. I see additional smaller round/oval irregularly shaped escoriations inside my labia. 

Thursday: thick odorless white cottage cheese looking discharge and even more lacerations appear. Doctor says I have a UTI and gives me metronidazole gel and nitrofurantoin mono/mac pills.

I did begin a new relationship in July. Before having sex we both took a 10 panel std test. We were both negative for everything except HSV1. He has it orally, I was diagnosed with genital HSV1 five years ago. No outbreak other than initial one. I think once the word "lacerations" and "lesions" are used, understandably people think HSV but that's why I wanted to show pictures. Its like nothing I've ever seen.

I'm not surprised you describe vaginal pain and visible abnormalities; otherwise you would not have wanted to send a photo. You need a vaginal swab for HSV PCR, as well as microscopy and perhaps culture to check for Candida (yeast). Even though your description of "lacerations" is atypical for herpes, which you obviously understand already, "round/oval irregularly shaped excoriations inside my labia" is an excellent description for herpes. An unusually severe yeast infection also is possible, and somewhat supported by "thick odorless white cottage cheese looking discharge". Both these descriptions could be used to each medical students about typical signs to look for in herpes and severe candida (yeast) vulvovaginitis, respectively. You might well have both.

If it's herpes, your symptoms and description suggest an initial infection, which would have to be HSV2, given your history of well documented genital HSV1. However, on rare occasions recurrent herpes can be just as severe as initial infection. If you had sex in the 2-3 weeks before onset of symptoms (and especially within 3-5 days and/or with a new partner), HSV2 is likely; if not, probably HSV1.

Get the HSV PCR as soon as possible, and you also should have both a culture and microscopical examination of a vaginal swab specimen for yeasts. Ideally test for HSV tomorrow, even though it's Sunday (e.g. at an urgent care clinic), and no later than Monday. Waiting too long risks a negative test result even if herpes is the cause.

Finally and just as important, even if the herpes and yeast tests cannot be accomplished immediately, and without waiting for results, it would be reasonable to treat you for both, i.e. to immediately start valacyclovir or acyclovir and either a vaginal azole product or the oral treatment (fluconazole, trade name Diflucan), or maybe both. Neither kind of treatment is harmful, and neither will interfere with diagnostic testing in the next couple of days.

I'm going to ask Terri Warren to take a look and provide her perspectives. In the meantime, good luck!

HHH, MD

To be sure we understand one another, you need an HSV PCR test, not a blood test. Probably either lab is equally reliable for HSV PCR testing, but make sure they don't stop at HSV without typing it -- i.e. they need to determine HSV1 or HSV2. 

Good morning, I looked at this post when Hunter told me about your situation.  I agree with Dr. Handsfield that what you need is an HSV PCR (or NAAT test if that's what the lab manual is calling it) with typing, if positive.  The fact that you've had symptoms for one week may mean that the swab might be negative for HSV but you are still infected.  I agree that this should be done today rather than waiting any longer.  to have this done.  The longer you wait, the less accurate a negative results might be.  I might also suggest that you wait to start treatment for hSV until the swab is done, which should be a very short time, so the antiviral medicines don't impact the swab test.  Are you able to go today?

Terri

Threads are closed after two follow-up exchanges, and we're there -- but I'll leave it open for any closing advice Terri might have. I hope the discussion so far has been helpful. Best wishes to you.

I would agree that if he is your only partner since testing negative for HSV 1 and 2, you don't need to do an HSV 2 IgG or blot.  However, if you do decide in the future to do any antibody testing, and you can afford it, I would do the blot.  More and more people are skipping the IgG test and going right to the blot because of the problem with false positives on the IgG test. 

So your symptoms could have been an HSV 1 recurrence or a really bad yeast infection.  Thankfully, you are getting better which is the most important thing

Thanks for checking in with us!

Terri