Herpes outbreak or yeast infection?

[jennifer4771]

I never in my life had sex without a condom and I'm very responsible with STDs. Every year I get tested. This year (March) I asked for all STD tests available (gonorrhea, chlamydia, herpes 1, herpes 2, syphilis, hepatitis A, B and C, HIV, HPV). I got negative results for all of them. The herpes one it was a type specific, the one that detects antibodies and my results were something like HSV-1 <0.34 and HSV-2 <0.27. But, two months ago I had PROTECTED sex with a guy much older than me and with a lot of sexual experiences.  
A week after that, right after my period, I had irritation, burning, itching, all over my vagina. I had a yeast infection before, and I had the same symptoms, except that this time I didn’t have vaginal discharge. I checked myself everyday with an 8x mirror, everywhere, and didn’t see anything weird, except for the irritation and swelling because of my constant scratching. I thought it was caused by the fact that I wore a pair of panties that I washed with Clorox and weren’t completely dry when I put them on. I DIDNT have any sores, NO blisters, NO red patches, the itching was all over (not in an specific location), DIDNT have vaginal discharge nor discomfort while urinating, no fever, no pain. I had the "normal" yeast infection symptoms!
Because I didn’t have any discharge, I wasn’t completely sure it was a yeast infection, so I used Vagisil, which helped but after a while symptoms came back. I used Monistat and worked perfectly, I felt a lot better. After the third day I was back to normal, I still had a little irritation left, but I think it was a consequence of all the scratching. I have checked myself every day, several times a day, for any signs of blisters, sores, etc, and nothing yet.
By your experience, should I suspect that I have herpes? I’m worried because I read that sometimes a herpes outbreak can be confused with a yeast infection.
Thank you very much for your advice!

[H. Hunter Handsfield, M.D.]

This sounds like a yeast infection, or some other sort of vaginal irritation other than herpes.  Even though many herpes websites and other education resources talk about herpes and yeast infections being confused, they don't put that information in context.  Some women with typical but mild herpes outbreaks just assume they might have yeast, because they haven't had yeast infections before and herpes just doesn't enter their minds.  When herpes is diagnosed some future day, they say "Hey, I thought I had yeast."  But once women know what symptoms to look for, it's generally quite easy to tell the two conditions apart.

The absence of vaginal discharge is not evidence against yeast.  If anything, your previous yeast infection might have been the atypical one; most yeast infections are not associated with increased discharge.

In other words, since you have had yeast before and now have similar (and very typical) symptoms, have not been at high risk for herpes (given consistent condom use), and you don't have any blisters or open sores in the irritated area, the evidence is strong that herpes isn't the problem.  That Vagisil cream helped somewhat doesn't mean anything; Vagisil contains medicines that reduce itching, no matter what the cause, but it doesn't effectively treat any infection.

Since you are concerned and nobody can make a definite diagnosis by self exam (or, in my case, by written description), you should see a health care provider.  You can expect him or her to confirm the diagnosis of a yeast infection.

I hope this helps.  Best wishes--  HHH, MD

[jennifer4771]

Thank you very much Doctor! You're so kind!

My previous yeast infection was caused by the use of antibiotics in February. At that moment I had the same symptoms I just experienced, but with a really tick and white odorless vaginal discharge. It was horrible! That was my first yeast infection ever and I didn't know how to treat it, so I used Vagisil and then Monistat. I was so desperate that I used both external creams at the same time and had a BAD reaction. My skin was so irritated that I couldnt even walk. I went to the gyn and she confirmed it was a yeast infection caused by the use of a strong antibiotic and gave me oral, intravaginal, and topical medication.

The recent one was a month and a half ago. I felt the same way I felt the other time, the horrible itching, irritation, desperation... without the discharge and without the reaction!This time the yeast infection symptoms were gone inmediately after treatment with Monistat. So I didnt go to my Dr. But, I have my annual appointment with my gyn this week...
1) if I ask her to, can she find out if I really had a yeast infection after almost two months since the infection?
2) If I want to get the blood test for HPV-1 and 2, is it two months after possible exposure enough time for the antibodies to show up?
3) How long should I wait to have "reliable" results?  

Sorry to bother you again!
Thanks so much for your time!

[H. Hunter Handsfield, M.D.]

I missed the use of miconazole (Monistat).  The prompt response to that drug really nails the diagnosis; it had to be a yeast infection.  Apologies for my oversight.

1) It isn't possible to confirm a yeast infection 2 months later.

2,3) Presumably that's a typo -- you mean HSV, not HPV.  I really don't see a need for it, but you certainly you could be tested.  Half the population has HSV-1, so a positive result won't mean anything.  If you happen to be positive for HSV-2, probably it would mean conclude you have asymptomatic HSV-2 plus yeast 2 months ago.  On the other hand, if negative for HSV-2 (and especially if negative for both viruses), it would prove that your symptoms could not have been due to herpes.  Please discuss the pros and cons with your own doctor, then decide.  If you do it, 2 months is too soon; wait until 3 months.

[jennifer4771]

Yes I meant HSV (herpes)!!! Sorry Doctor! And ok I'll wait until 3 months!

Also, do you know anything about the chances of getting HSV with the use of a condom during vaginal sex?

This would be my last question, wont bother you anymore :)
Thanks for all your help!

[H. Hunter Handsfield, M.D.]

Even without a condom, the risk of catching HSV from any particular sexual encounter -- assuming the partner doesn't have known genital herpes -- probably is only one in 1,000 or lower.  With a condom it's probably 10 times lower.  These are only guesstimates and you shouldn't focus on the exact numbers.  The point is that the chance you were infected is very low.

[jennifer4771]

I'm sorry! LAST question hahaha
But what if one partner has it, but the other dont... what are the chances of getting HSV with a condom during vaginal sex?

[H. Hunter Handsfield, M.D.]

OK, I'm holding it to you this time.  No more questions after this one.

In monogamous couples in which one person has HSV-2 and the other doesn't, and who have unprotected sex an average of 3 times per week, the infection is transmitted in about 5% of couples (1 in 20) per year.  That translates into a very low risk for each episode of unprotected sex. With condoms, it should be 5-10 times lower risk than that.

For a variety of reasons, the transmission rate may be higher in such couples than in, say, singles who are dating.  But still, the chance for any particular episode of unprotected sex is quite low, and lower still when condoms are used.  But there are no data on which to calculate a precise figure.