Could this be herpes?

Hi! I'm a 40 year old male and my girlfriend is 36. We recently got back together after a year and a half of seperation. Neither one of us were very sexually active during the break. However, we've been very active for the past 3 months since reuniting. Within a few weeks of being back together she began experiencing what appeared to be all the symptoms of a UTI. Pressure in her abdominal/bladder region, slight fever, fatigue inability to urinate(or not much of a need to), etc...
Her doctor prescribed an antibiotic and it seemed to go away. It has come back 3 additional times. All the same symptoms except this last time. This time she has pain during urination and a small rash above/around her genital area. It looks like a group of ingrown hairs or pimples not like the sores/lesions I've seen associated with herpes. We are monogamous and have unprotected sex but are both std-free or so we think. Are there urinary tract infections with symptoms so similar to herpes? i.e. painful urination, fever, fatigue and a rash. We've been more "open and experimental" so I'm wondering if this could just be a bad, reoccurring infection as a result of bacteria from the back finding it's way to the front so to speak? Or does this sound like herpes?  Oh, and she has crones(I'm not sure how to spell it) disease. I don't know if that could be playing a part. Help!

[H. Hunter Handsfield, M.D.]

On one hand, herpes symptoms can be highly variable.  So the literal answer to the question, as posed in the title of your thread, is yes, I suppose it could be herpes.  But it really doesn't sound like it.  I can't comment on the "small rash" in her genital area - but if it looks to you like ingrown hairs or pimples, I suppose that's what it probably is.

But most important, if your partner has symptoms of a UTI, that sounds like a good bet.  The symptoms you describe for that sound compatible, but not quite typical; but if she has had UTIs before and has the same symptoms now, that's probably what it is.  UTIs often are triggered by sex--not an STD, but because sex massages genital area bacteria into the urethra.  The historic term "honeymoon cystitis", not used much any more, tells it all:  UTI associated with increased sexual frequency.

Bacteria that are normal resident in the rectum (like E. coli) often colonize the vaginal area and then cause UTI. To my knowledge, research has not associated UTI with anal sex (which is what I assume you mean by bacteria "from back to front"), but that may be just because researchers haven't asked the question, and I am certain it contributes to movement of rectal bacteria to the vaginal area and increases the risk of UTI.  Heterosexual couples who practice anal sex should wash with soap and water before moving from anal to vaginal sex; or perhaps use a condom for anal sex, then remove the condom before vaginal.

The standard, bottom line advice applies:  Your partners needs to see a health care provider for diagnosis and probably treatment.  If that provider thinks herpes is possible, then perhaps diagnostic tests should be done in you and your partner.  But I doubt that's the problem.

Good luck--  HHH, MD