Am I worrying too much?

[Cassandra76]

Thank you in advance for your time.  Back in April (4/28/06) I had sex with a guy I was casually seeing at the time.  He performed oral sex on me, used his hands and a condom was used the entire time of actual intercourse to my knowledge.  About a week later I began having periods of intense itching, i scratched, rubbed and inspected myself everyday.  I started developing tiny fissures at the top of my clitoris and where my labia majora and minora meet.  After using neosporin and other remedies, I went to the doctor (exactly 7 days later) and was tested for yeast, trich, bv, gonorrhea and chlamidya all which were negative.  I never had much of an abnormal discharge or odor however this white pasty discharge developed on the sides of my labia majora, I would wipe it off and this skin would itch and with a magnified mirror I would see small open areas (pinpoint).  I tried a monistat cream however it burned so i stopped.  I chalked my symptoms up to my paranoia/anxiety and used hydrocortisone cream which helped with the itching some and the fissures healed.  This cycle of itching off and on and discharge has continued until now.  I stopped inspecting and overly cleaning myself and have started the monistat cream again 3 days ago which has helped (being a nurse, i figured the previous burning was from the fissures)and the white discharge has began to subside.  I am extremely paranoid of contracting a disease.  (2 years ago my partner removed the condom and i ended up with trich and a uti, when previously had nothing and last year i was diagnosed with abnormal pap d/t hpv my last 2 paps were negative) since then i have been overly anxious after sex encounters and am try to remain celebate (for as long as i can) for those reasons.  My question is should I be concerned about herpes or hiv?  Mainly herpes because of the reading I have done about people being asymptomatic.  I asked my partner and also inspected him prior to intercourse and he said he was clean.  But if he has never had symptoms is that something I should worry about and be tested for when I go to the doctor for my yearly exam?  And would the symptoms I described suggest herpes or anything else? Your response is greatly appreciated and would ease my mind. Thanks again

[H. Hunter Handsfield, M.D.]

You give a classical story for candida (yeast) infection, particularly the combination of itching, superficial fissures, and scant "white pasty discharge" that adheres to the labia.  I have to think candida is a strong possibility, even though your provider wasn't able to diagnose it.  Hydrocortisone indeed would help the symptoms in the short run, but in the long run can help candida grow even more vigorously.

Herpes can mimic yeast, because it can cause soreness and itching.  But herpes would come and go over several days, not cause persieting symptoms of the sort you describe.  And there certainly is nothing in your description that suggests an active HPV infection.

You should return to your provider for reassessment, especially with candida in mind.  Unless s/he sees something that suggests an STD, at this point I see no need for your partner to be evaluated.  I doubt this has anything to do with him.

Best wishes--  HHH, MD

[HHH,MD]

I forgot to comment that the improvement on self-treatment with monostat also favors candida.  If your symptoms have cleared up entirely, you probably don't need to go back to your provider unless/until they recur again (which they may; recurrent candida is common).  In that case, however, definitely return for proper evaluation.  Self-treatment for candida should generally be done only after professional confirmation of the diagnosis at least once; then OK to rely on self-treatment for recurrence of the identical symptoms.

HHH, MD

[Cassandra76]

thank you dr. h ... i continued with the cream and have had not further symptoms, my final question is.  is it possible to have a yeast infection that only affects the outer labia and not affect the vagina?  (since i was negative for yeast during vaginal exam) thanks again