Another herpes Question.

[DJEJ]

Hi Dr Rockoff,

Three months ago I had a strange rash on my vulva(mucousal area, not the hairy area).  The first time it appeared my entire vulva went red and and in a few places I had what kind of looked like blisters.  However, they did not have any fluid in them (put a pin in to check) they were white, looked delicate but were firm to touch.  Some were so tiny (Pin head size), they had already started to go away and some were about half a mm long if that.  They were spread out and there were four or five in total. My vulva stung when it came into contact with wee (only reason I noticed rash).  I freaked out and went to a clinic, the Dr took a quick look and said "definitely not herpes just irritation".    The redness went down after a couple of hours and no more stinging and I scratched one of the bumps to see what would happen, it came off and bled a tiny, tiny bit but after an hour I couldn't even see where it had been.  The other bumps hung around for three/four days and then went away.  No bleeding, oozing or scabbing.  Two days later my vulva looked normal.  A week later a couple of these bumps came back and I just ignored it and scratched the bump off, again the next day, there was nothing to be seen. There wasn't as much redness this time.  Not even two weeks later I noticed two of these tiny bumps and they were side by side, not spaced out.  In a different spot.   I freaked out again and scratched one to see if it had fluid in it. It didn't. The other kind of went away but there was a tiny light, rough patch where it had been(half mm long). I went to my doctors about 40 hrs later and he did a PCR and viral swab on the area but had to be shown where to swab because he couldn't really see anything .  I also had a slightly roughened area on my vulva which came up at the same time.  He tested this also. My Dr felt it could be aytypical herpes as it was recurring but thought it was probably almost too close together. Results were negative.  About a week later some rough patches came up in the same spot and a slightly raised area came up in the spot that the last two bumps had been.  I went back to the doctor and he tested again.  Also, Negative.

Despite this, I can't let it go. I am concerned because although these white papules did not have fluid in them they did kind of resemble blisters. I cannot think of anything that could have caused the rash except sweat or heat, perhaps combined with some faeces from wiping back to front. Maybe my hemarrhoid cream.  I hadn't had sex for ten months prior to the first rash and three months later it has not come back.I plan on getting a blood test but I am petrified.

My questions are:

1. Do you think this could be atypical herpes?
2. Can herpes recur so closely together?
3. What could this be if it is not herpes?
4. If it was recurring so often would it still be now if it was herpes?
5. Likelyhood of culture being negative in absence of fluid?

Sorry about the length of this, thanks for your help!

[Alan Rockoff, MD]

I can't answer your questions with any precision, certainly not better than the doctor who examined and tested you.  There are many things that cause bumps other than herpes.  I think you should indeed get a herpes type 2 blood test.  If it is negative, as I am confident it will be, then perhaps you will be able, as you put it, to let it go.  

For answers to the rest of your questions (what else could it be, etc.) I advise you to see a dermatologist.  Before you go, please do not scratch or rub the area, so the diagnosis will be clear.

Take care.

Dr. Rockoff

[DJEJ]

Also, in September I treated what I thought to be thrush. Mu vulva was red, hot and itchy.   After using the cream on this area my vulva was quite dry and a little cracked in one place.  I stopped using the cream and took diflucan.  The irritation then dissapeared after a couple of days.  Do you think this sounds like thrush or could it have been herpes as well?  I know neither of my symptoms are typical but according to the websites just about any of the symptoms you can have on your genitals can be herpes related.  Sorry to be parnoid but I am totally freaking out!

Thanks heaps again!

[DJEJ]

Hi again,

I apprecite that from a distance of course you cannot answer with any great precision but basically I am looking for just a little bit of reassurance before I get tested.  I can't sleep and I can't eat because I am so worried.  Can you please just give me some suggestion as to maybe what could cause this.  I understand it is not a diagnosis and I will not take it as one but as I have nothing else to atleast suspect I keep telling myself this is herpes.  Also could you please answer my question regarding the recurrence time between outbreaks.  Do you think mine were too close? Basically what I want to know is are herpes blisters always fluid filled. I understand you are  busy but please respond!

Thankyou, and I really do appreciate any information you can give me.  Like really really really appreciate it!

[Sore pussy]

I have just come back from the doctors, and I'm quite freaked out.  I get swelling around the left side of the external urethral orifice.  It olny seems to happen sometimes after sex.  There are no plisters, warts, itching or burning ever.  My doctor has never heard of anything like this thinks it maybe wise to have intercourse in the morning and come and see him.  While this is a nice idea I'm worried now and would really appericate some quick reassurence.  It has happened over a period of two years maybe ten times.  It makes any form of touching in the area uncomfortable and a little painfull (plus I find it unsightly to have a round lump on one side of my girlie bits)