Could it be more than yeast?

[McQ]

Hi Dr. HHH,
I am having a variety of issues. Befor x-mas I had strep throat, was put on amoxicillin and had a yeast infection 2 days after completing medicine. Two and 1/2 weeks after starting the meds I came down with strep again, so the doctor tried Augmentin. Again 2 days after meds, I developed what I think is a yeast infection. This one seemed more severe than the last--my labia was very swollen as was my clitoris area.My GP prescribed Dilucan over the phone and I took it on Thursday afternoon.Within 2 days the itching definitely subsided, but I was still sore over the weekend. NOw, my soreness is better except on a few small pustule-like sores that I noticed on Saturday: two on my left labia and one close to the hood of my clitoris.This area has been very sensitive for the last 3 or 4 days. Ths sores on my labia appeared before the one on my clitoris. I am raw in my perineum area, but there are no sores. To make matters worse I am having a bout with hemorrhoids which are very painful. I cannot tell anymore where my pain is coming from. My husband noticed a slight irritation under his foreskin yesterday and went right to a clinic--they assured him it was not herpes, but most likely he caught the yeast from me. I am terrified that my sores are indicative of herpes. I have never examined my genitals during previous yeast infections, so I don't know if I have had them before.The hemmorhoids I have experienced in the past, so i am fairly confident that is what I have in the anal area. I have looked at them and they are not ulcerative or even very red. I am wondering if the achiness I am feeling down below is more about the hemmorhoids or the yeast or if I have something worse. I have never experienced a bout with herpes, nor has my husband. We had fairly rigorous sex on Monday ( the day before I started itching ), so I wonder if we did some damage to the delicate skin? Please let me know what you think. Would a brand new herpes infection coincidentally appear after a 10 cycle of Augmentin? Or could I possible have yeats, herpes and hemmorhoids all at once? Thank you for your help!!

[H. Hunter Handsfield, M.D.]

Your symptoms are entirely consistent with yeast inection, and not particularly typical for herpes.  Genital herpes generally causes discrete sores, with surrounding tissues entirely normal.  Severe yeast infections can include pustules or open sores, but always in the presence of diffuse inflammation of the surrounding tissues; i.e., generalized redness and irritation that includes sores, not sores along.  Your description sounds most like this.  Also, although you don't describe the time frame precisely, I get the feeling you've been having symptoms more or less continuously for a ocuple of weeks, which would be atypical for herpes.  And to answer your specific question, antibiotics do not trigger herpes outbreaks.

None of this is certain, of course, and it is true that yeast infections and genital herpes can be easily confused with one anohter.  The only way to know is to consult with a qualified health care provider and to be tested.  But if your provider is experienced in such matters and is confident you don't have herpes, you may not need to go further.  Because 25% of the population is infected with HSV-2, you and/or your husband could have a positive blood test, but it wouldn't prove your symptoms were due to herpes.  Discussing it with your provider also is the way to sort out the symptoms due to hemorrhoids, yeast, herpes, or some combination of them.

Good luck--  HHH, MD

[McQ]

Thank you so much for your response. What do you mean by discreet sores? The ones I have appeared when the areas were swollen and sore. They have not really changed in appearance in the 3 or 4 days I have had them--very small, white head, not clustered together. I would not see them at all unless I was really examining in bright light with a mirror. If I had herpes wouldn't there be other symptoms since this would have been my first outbreak? Thanks again.

[H. Hunter Handsfield, M.D.]

"Discrete" wasn't the best word to use, but I sort of definied what I meant; think of it as an "isolated" sore, i.e. the sore is the only abnormality and the surrounding skin is normal and not sore, red, inflamed, etc.  Non-clustered lesions that haven't changed over 3-4 days does not sound like herpes, and from the more detailed description it might be entirely normal.  But you cannot rely on anybody's opinion just from verbal or online description, including mine.  You need to show the lesions to a knowledgeable health care provider.

HHH, MD