Unexplained vaginal discharge

[silver_0]

Over a year ago I made a huge mistake and had sex with a man I didn't know.  He admitted to having 30+ sexual partners and also admitted that he did not usually use condoms.  He infected me with HSV-2 which I found out that I had through a blood test, I have not had any visible outbreaks.

Since then I have had unexplained, uncomfortable vaginal discharge.  The discharge changes throughout my cycle:

(1) Period: generally symptom free with some random waves of itching/burning
(2) Strong smelling discharge that is green/yellow and cakes on the sides of my vagina, waves of itching/burning, the area is very irritated, pain when urinating and wiping the area
(3) Clear egg white discharge mixes with the discharge described in (2) and makes the symptoms less severe
(4) White discharge that burns/itches and irritates the area, redness, pain when wiping

I have been working with a nurse practitioner and she said that in (2) the discharge appeared to be BV since the pH was off, and the discharge in (4) appeared to be yeast.  I have been treated for both, the meds for BV didn't do anything, the yeast infection creams do help relieve the symptoms but only during (4).  Diflucan does not do anything.

The nurse practitioner I have been working with told me she can no longer help me since none of the medications are doing anything and she doesn't understand my condition.  It keeps getting worse and worse, I feel like I should run to the emergency room it's so itchy.

(1) Do you have any idea what is wrong with me?
(2) Can you recommend a specialist in the Miami, Florida area (I can also drive to Ft. Lauderdale)?

[Elaine Brown, MD]

Hi!
I'm sorry for the delay in response--was very ill for awhile

I have often wondered whether some of these cases of vaginal discharge that don't respond to medications are actually caused by herpes 2.  If that is the case, your symptoms might respond to an antiviral agent such as acyclovir.  It would definitely be worth a try.

It also sounds like you have yeast, and fairly significant amounts too.  I prefer diflucan when treating yeast, and have had more than one case that required fairly lengthy treatments of 1-3 months.  Some women seem to have to take it every month.

One thing that is important--topical treatments can cause a dermatitis that can be worse than any infection.  For this reason, I like to avoid topical/intravaginal therapies.
Other than something like Boric acid (which might work for you too).

Crisco or other vegetable shortening can really alleviate the itching and irritation  and won't cause a reaction, so I often have my patients use this externally while we are trying to sort out the cause.

Two other things I should mention, you probably ought to be tested for diabetes and HIV if you haven't already been.

I don't know anyone in to recommend in your area--sorry.

Good luck!
Dr B

[akronite]

I've had some similar issues, and in looking for an answer, came across the article in an online nursing journal. There were several other related articles as well:

Try printing and taking this to your doctor/NP:
http://www.ispub.com/ostia/index.php?xmlFilePath=journals/ijanp/vol6n1/vaginosis.xml

The article citation: P. Korenek, R. Britt & C. Hawkins : Differentiation Of The Vaginoses-Bacterial Vaginosis, Lactobacillosis, And Cytolytic Vaginosis .  The Internet Journal of Advanced Nursing Practice.  2003 Volume 6 Number 1

It goes over several similar issues and how to tell the difference between them.

Hope you find an answer soon!