Atypical herpes?

In the past year I have experienced three typical vaginal yeast infections with adherent copious white discharge and vulvar erythema, tenderness, and pruritis. Two of the three occured within 5 days of completing broad spectrum antibiotics (h.pylori tx and chronic sinusitis). All infections were treated with a one time dose of flucanazole (oral). With each of these infections I also noticed painful fissuring of the labia majora and minora as well as the clitoral hood. During the last infection (also following antibiotic use) I noticed both fissuring of the clitoral hood as well as a painful shallow ulcer on the clitoris. Moreover, the last infection required a second dose of flucanazole to treat. The fissures bleed if on skin and ooze if found on the mucosa. These lesions last less than three days. There are NO preceding vesicles. There are no associated signs or symptoms of herpes. No history of sexually transmitted diseases and normal PAP smears. I am concerned that I may be experiencing an atypical herpes outbreak instead of associated symptoms of vaginal candidiasis. What do you think? Do you recommend I screen for HSV1 and 2 with serum antibody testing?

[H. Hunter Handsfield, M.D.]

Fissuring is common in severe yeast infections.  If these events indeed were typical yeast infections, especially if they responded promptly to fluconazole, there probably is no particular reason to be suspicious of herpes.  Further, the confusion of herpes with yeast infections is pretty much limited to initial herpes.  I have not seen cases of recurrent herpes that were easily mixed up with yeast.

Having said that, I cannot make an accurate judgement for any particular patient.  If you are at risk for STD, or otherwise have concern about herpes, you certainly could be tested.  But there is nothing in your story that makes me especially suspicious.

I hope this helps. Good luck--  HHH, MD