Herpes or What

Background: My boyfriend (33yrs old) & I (23 yrs old) have been together off & on for 4 years, and have been exclusive for the past 1 1/2years. I get an STD test yearly. The only known STD I have been shown to have is HPV, one of the high risk types.Last Sunday we were out on the river, I was in a wet swimsuit all day & night, called my doctor Wed. told her symptoms (itchiness & redness around entrance of vagina, no bumps or any sores) and she prescribed Diflucan. I've had 1 yeast infection before so I was pretty sure this is what I had. Tues night, before I realized that I had a yeast infection, my boyfriend & I had unprotected sex, and then he performed unprotected oral sex on me.  The next day (when I called my doc about the yeast infection) my boyfriend complained that his bottom lip was sore and there was something developing on it.  I asked my obgyn about it Friday right before (2nd) LEEP surgery and she said she didn't know of a yeast infection doing that (after also saying that she doesn't study men). She then said something about the possibility of Herpes, but said she has never seen anything unusual on me. I saw his lip and the bottom lip has what looks like a cluster of little blisters or small pimples and is a bit swollen and he says it hurts/ is sore.
1.  Did the yeast infection cause him to have this reaction?  Like I said, it is only on his bottom lip (the part that he says he uses when giving me oral sex), there is nothing on his penis that he has complained of, and there is nothing on my vagina.  I took the Diflucan Wed. night & believe my yeast infection is almost all cleared up.
2.  Could this be HSV2? I thought it didn't show up the next day & rare on the lip...
3.  Could I have been misdiagonosed & had some other bacterial infection that caused this?  Is this just a severe outbreak of HSV1 on his lip?  He does get cold sores several times a year. He says he has never had it this severe before. Thank You for any help.

[H. Hunter Handsfield, M.D.]

Directly to your questions:

Herpes is a real concern here; certainly "a cluster of little blisters or small pimples" and swelling of the lip are classical symptoms.  Yeast might cause it, but probably without the blisters/pimples; oral yeast infections usually are just red and a little irritated, and probably wouldn't cause swelling.  On the other hand, you are right that your partner could not have developed herpes symptoms the next day after exposure; it takes at least 2-3 days.  As you seem to know, the symptoms of vagainal yeast infection and herpes can be similar.  The prompt clearing of you symptoms on diflucan suggests you had a yeast infection; but even if your symptoms were herpes, it could be it was going to clear up anyway; or you could have had both problems. And since your partner has recurrent oral herpes, it seems possible he is just having a recurrence, even though it is more severe than usual.  If the location of his outbreak is in the same general area of his other recurrent outbreaks, that favors the notion of simply having a worse than usual outbreak.

As for "some other bacterial infection", that is not likely.  Bacterial infections of the vulva are rare.

If your partner's oral lesions are still pretty new (within 2-3 days of onset), he should immediately see a health care provider and have a test for HSV, including a test for virus type if the culture is positive.  Barring that, you both should have type-specific blood tests for HSV-1 and HSV-2.  You can expect his HSV-1 result to be positive; the test will tell whether either or both of you also has HSV-2.

Bottom line:  I cannot sort this out with any definite opinion.  Herpes is possible, and it could be you are infected with HSV-2.  Follow-up with your health care provider(s) and ask for the lab tests suggested above.

Good luck--  HHH, MD

[dianimal]

A related discussion, Bacterial Vaginitis was started.

[court243]

A related discussion, Raw whitish skin was started.