Can vaginal sores be a result of a severe yeast infection?

I was recently studying abroad for three months and began having problems with severe yeast infections. Over the course of the three months I had four or five and the symptoms were very severe. Some of my other friends there had them too and they just itched, while I hurt. The last one I had started occurring a few days after my boyfriend and I had (unprotected) sex - which was slightly painful because the last one had never really gone away. Two days later, a Friday, I got my period and for two days I put tampons in, but it became too painful so I started wearing pads. On Monday I went to the hospital with my vagina extremely red and swollen and painful but they said I had to wait Thursday, when my period stopped, to be treated because they couldn't do an exam. On Wednesday night I discovered a canker sore on my labia, and over the course of that night I developed two more. By the time I went to the hospital I had about eight. They told me these were symptoms of an untreated yeast infection, and prescribed me 3 days of bed rest to minimize irritation, gave me ovules for the yeast infection, antibiotics for the infected sores, and yeast infection cream. For the first two days of bed rest I was supposed to put cold compresses to help with the inflammation and take the antibiotics, and then afterward start the yeast infection medicine. The inflammation went down somewhat with the compresses and bed rest, and as soon as I started the other medicine the sores started disappearing. They were completely gone after about six days. At the same time I also had strep throat, so I had some flu symptoms which I know are a symptom of herpes but am hoping that was just because I had strep throat from my immune system being down? I have never had a good immune system and get sick very often, and often have very bad reactions to being sick, especially if I'm not treated right away. I never had a yeast infection before this trip and don't know the symptoms - could this be herpes?

[H. Hunter Handsfield, M.D.]

Welcome to the STD forum.

The direct answer to the question as you posed it in the title is yes: severe yeast infections can cause ulceration.  The presence of diffuse inflammation tends to favor yeast over herpes.  On the other hand, it certainly is possible that herpes is the problem.  However, even though genital herpes of course can recur frequently, the several episodes you had within 3 months is does not favor herpes but certainly could occur with yeast.  An additional clue that might help is whether or not you had lymph node inflammation in the groin, i.e. tender swellings in that area.  Initial herpes usually would cause that but yeast usually does not.  The "strep throat" might suggest herpes, since many people with initial genital herpes also get oral infections -- and the symptoms and signs are similar to strep.  (Was the strep diagnosis made only by visual examination, or was there a positive strep test?)

Putting it all together, I suspect this indeed was a yeast infection, not herpes.  However, that is not at all certain.  You should speak with your health care provider(s) about it, in particular whether testing for HSV would be a good idea.

Most of the time when someone believes their immune systems are weak, in fact there is nothing wrong at all.  However, you do describe some fairly dramatic reactions to usually mild infections.  Most likely it has just been bad luck, and certainly most vaginal yeast infections are not as severe as yours or come back so quickly.  But there are some rare conditions that could result in this sort of thing.  I would be especially concerned if skin infections -- recurrent boils and that sort of thing -- had been a problem, especially during your childhood.

Somewhere along the line, this might be something worth investigating with an infectious diseases specialist.  Don't be alarmed -- it isn't necessarily serious.  But discuss it with your primary care provider, perhaps after your travels are done.

Good luck--  HHH, MD

[Janedoe123]

I did actually have swollen lymph nodes all over, groin, neck, etc., but about a week and a half after the sores had shown up, so way after they were all gone. And the "Strep throat" wasn't confirmed with a strep test. I am getting a HSV test done but am now very, VERY nervous. Could this still be the result of a yeast infection and irritation from the sex and tampons?

[H. Hunter Handsfield, M.D.]

It could be that more than one thing was going on.  For example, yeast infections can flare up in the presence of initial genital herpes; I have seen both problems at once in several women over the years.  With this information, herpes does indeed seem a bit more likely than I though yesterday. It's too bad a test for HSV wasn't done (apparently) when the sores were fresh.  Assuming the open lesions and throat inflammation have resolved, you need a blood test now for HSV-1 and HSV-2.  Also, your sex partner should be examined and tested for HSV.

Don't misunderstand -- I'm not concluding you have herpes.  But it is reasonable to do the tests to learn for sure.

[Janedoe123]

Thank you very much for all your help. So just to be sure, it is definitely still possible this could just be a bad reaction to a very severe yeast infection? Also, will the test results be accurate this soon after my outbreak? It happened about 3 to 4 weeks ago. I'm worried about getting a false positive and absolutely freaking out when it could potentially be an issue that has been resolved. Thank you.

[H. Hunter Handsfield, M.D.]

The lymph node enlargements are not likely due to yeast.  But several things other than herpes could be responsible for that finding plus the sore throat.  To be sure nothing serious is missed, a syphilis blood test would make sense and perhaps also a test for mononucleosis.  Also, not to alarm you, but acute HIV infection is a theoretical possibility -- although extremely rare in situations like yours.

At 3-4 weeks, there is roughly a 50% chance the HSV blood test will be positive.  If so, it won't be possible to know for sure whether it reflects a recent versus older infection; blood tests say nothing about how long the infection has been present.  If positive for HSV-2, it will likely mean that's what caused the recent illness, but not certain. Positive for HSV-1 would be meaningless, since half of all adults have positive HSV-1 tests.  The "ideal" outcome -- not that having herpes is ideal, only for certainty of test interpretation -- would be negative for either type now, then positive a few weeks later.  That would prove recent infection.

In the meantime, please do follow up with your partner and ideally have him tested.  If it turns out he has HSV-2, that would pretty much nail it for you.

Don't worry about a false positive HSV test.  That's not a common problem.

[Janedoe123]

I just got my test results back and they were negative for HVS 1 and reactive for HSV 2, but my doctor sent in more tests to be definitive about thos. I am still waiting to get back the full test results to see if they are diagnostic for HSV 2. Could this still come back as being negative? Thank you.

[H. Hunter Handsfield, M.D.]

By itself, a positive blood test can be misleading, but it is highly reliable in a situation like yours, i.e. with a clinical picture like yours.  It may be that your HSV-2 test will be only weakly positive.  If so, it should be repeated after ~12 weeks, at which time you can expect a strongly positive result.  For now, you should assume you have genital herpes.  I'm sure that's not happy news, but at least the uncertainty is over and you can move forward.

[Janedoe123]

What should I know about not passing it on to a future partner as far as oral sex, and regular sex go? What are the chances I could pass it to him even if I am outbreak free and we use a condom?

[H. Hunter Handsfield, M.D.]

The topic of preventing HSV transmission is very complex and has been addressed many times on this forum.  The 3 basic methods are avoidance of sex if and when there are symptomatic outbreaks, consistent condom use, and suppressive therapy with one of the anti-herpes drugs.  For details, use the search link and enter such terms as "herpes prevention", "prevent herpes", and "herpes transmission".  Also see some good websites, like www.ashastd.org, www.westoverheights.com, and www.cdc.gov.  Also you might start a dialog on MedHelp's herpes community forum (no cost).

You're going to need to get into the habit of routinely informing your potential sex partners of your infection before getting intimate.

An important aspect that might not be covered in previous threads:  HSV-2 is maximally transmissible in the first 6 months after catching it.  Great care is required to prevent it during that time, after which transmission risk is lower.

[Jenlisa]

I am
In need of much help. I was prescribed an antibiotic for an bacterial infection, along with this he also prescribed Diflucin for possible yeast infection. 3 days into the meds I began to have a severe yeast infection, unlike ever before. I took the diflucin on a Saturday and still by Monday I'm dying. Took another diflucin Monday. Tuesday I'm not only still in extreme pain but I have now rubbed myself raw and caused sores. Similar to the ones on a penis with a yeast infection. Open raw skin. What do you think? What should i think? Herpes? Nothing started until that antibiotic.

[wonderwhy996]

A related discussion, What is going on?! was started.