Herpes vs. Bacterial Infection

[jmcc85]

Hi Doctor,

At the beginning of February I developed cuts in both corners of my mouth due to eating a large quantity of pineapple.  About two weeks later I went to emerg as the cuts had not healed and were becoming infected, bleeding, emitting pus, and growing in number all around my mouth.  I was given ten days of amoxicillan.  At the end of my round of amoxicillan (I was also just finishing my period) I started noticing little cuts around my anus and vagina, and the tender area between the two.  Whenever I wiped there was blood on the paper.  I tried not to itch, but I did scratch from time to time.  The rash started becoming more painful and spreading and also emitting a yellowish substance that scabbed a bit.  After about a week of this a red rash has cropped up all over the area around my anus and vagina, and red scab-looking areas have started to show where my pubic hair is (on top).  I also feel raw sores around my labia and they seem to be emitting yellow-ish looking fluid.  It is itchy and sore and there is still blood on the toilet paper from my anal area when I wipe.  Does this sound consistent with herpes, a cross-infection from my mouth infection, a new infection due to the antibiotics, or a combination of all?  I should mention that I do have a history of BV, yeast, and other fungal infections and have never had symptoms of herpes before.

Any insight is greatly appreciated.

[jmcc85]

Hi there,

After my last comment, the folliculitis on my pubic region worsened.  I had a lot of redness, swelling, and intense pain.  I was prescibed Keflex for ten days, which I finished on Saturday.  The folliculitis is mostly cleared up - it appears as though the skin is healing as there is a bit of flaking, and the redness has definitely toned way down.  The only issue is that I have just today noticed the same symptoms that I started out with, this time right around my anus and not at all in the vaginal area.  There is a mild itch and a sting, a bit of redness, and when I wipe there is some off white material on the paper.  Often having a bowel movement results in cuts on my anus - perhaps bacteria from my stool is entering these wounds.  Perhaps it is yeast from being on antibiotics again.  My hope is that this will clear on its own but my fear is that it will worsen, and I will continue this ongoing two month nightmare.  Any advice is appreciated.

Thank you.

[Edward W Hook, MD]

Thanks for the follow-up.  Take care.  EWH

[jmcc85]

Hi Doctor,

I am very happy to report that the herpes cultures came back negative.  I have an appointment for next week to see if I can get this properly diagnosed as folliculitis.  The weeping rash has cleared up, as I stuck to a pretty strict diet of no sugar and lots of natural yogurt.  I will let you know if folliculitis is the culprit.

Thank you so much for alleviating my fears and offering your expert opinion.

[Edward W Hook, MD]

Thanks for your clarification. This, as well as the description of your lesions, (the red bumps and "white heads") are really more compatible with yeast and or bacterial folliculitis than HSV.  I predict your cultures will be negative.  Take care. EWH

[jmcc85]

Thank you for your reply, Dr. Hook.

A note about exposure:
I am in a monogamous relationship with a man who has said that he has never had any signs or symptoms of oral or genital herpes.  We began having unprotected sex two weeks prior to the appearance of this rash, which I know seems to be perfect timing for a new herpes infection to appear.  He had no physical evidence of herpes at that time, although I know it is possible to transmit without visible symptoms.

I have been to the doctor and she did a swab for herpes.  I will find out the results in two weeks time and will let you know what those results are.  Intuitively, I feel that the majority of my problems are due to yeast/bacteria due to the antibiotics but know that the worst case scenario is that I acquired herpes from my boyfriend due to the cuts that I had, along with a suppressed immune system due to menstruation and antiobiotics.

A further note regarding the symptoms - I have noticed that the rash looks like a lot of tiny red bumps very close together in some areas.  In the hair bearing region, there are two or three white-heads along with the redness.

Thanks for your time.

[Edward W Hook, MD]

Welcome to our Forum.  I'm betting on a bacterial or even yeast infection.  While I will elaborate on why I doubt that this is HSV below, I suggest that you have a health care provider take a look.  This may be a persistent yeast infection.  In addition, antibiotics alone can also sometimes cause rashes which have a tendency to "weep" and remain present even after you have stopped taking antibiotics.    Depending on what they see they may be able to prescribe something to help clear things up more quickly

As to why this is not HSV, while you do not say anything about exposure, I can tell you that spreading HSV from one part of the body to another by scratching or other modes if transfer almost never happens.  In addition, when HSV lesions occur they typically are clean based as opposed to being associated with yellowish material which may be pus.  

Hope this helps. Please let us know what your doctor says.  EWH