Hello- a year ago I had unprotected oral sex with a man with a history of cold sores. He said that at the time he didn't have one, and he didn't appear to have one on his mouth. However, a few days after we had sex, I had all sorts of vaginal pain, itching, and discharge, and a rash on my behind. I went to my gynecologist, and she told me it was a yeast infection and that the rash was just a heat rash. She cultured my vagina for herpes and it came back negative. I didn't have any flu-like symptoms or anything. I also never had any typical clustered sores, ever. I do have a history of yeast infections, but never in the anal area.
A few months later, I got the buttocks rash again, and some vaginal and anal pain. It lasted for a couple weeks. This happened again in the fall, and lasted for about 3 weeks. I had a lot of anal pain and itching, and it burned when I urinated. I went back to my gynecologist and she referred me to a specialist, who didn't think I had herpes, but cultured me and gave me some Valtrex as a precaution. The Valtrex didn't help, and neither did the Diflucan or Terazol. Finally, the doctor had me get a HSV-1 and HSV-2 bloodtest, the kind that can tell the difference between the 2. I had the blood test 6 months post-exposure. The HSV-1 test came back as .60 and the HSV-2 at .16, which the doctor said were negative. I felt better.
However. For the past 3 weeks now, I have had major vaginal pain, especially during urination, and pain while having a bowel movement. I also have itching back there, and a little bleeding on toilet paper- it looks like there's a fissure there. I went to an STD clinic and the nurse practioner diagnosed me with yeast and an anal fissure, and gave me Terazol and Diflucan, which is not working. Could this be anal pursitis, or does that usually happen only during an initial outbreak? I am terrified that I have genital HSV-1 herpes and that the blood tests were wrong. How accurate are they? Should I stop worrying and think it's something else, or get re-tested via blood? I'm frazzled because I don't have good health insurance and am afraid of giving this to my partner. I heard that genital HSV-1 rarely comes back, and I've had this 3-4 times in the past year, and it's always lasted at least 2 weeks. Thank you...
You can be confident you don't have genital herpes. The negative blood test result definitely rules out infection with either HSV-1 or HSV-2, of any body site. And if your symptoms had been due to herpes, they definitely would have improved on Valtrex.
You probably mean anal pruritus (also called pruritus ani). The term literally means itchy anus, nothing more; and herpes is not the most common cause of that symptom. When itching does occur with herpes, that's primarily with recurrent outbreaks.
As to what is actually causing your problems, I really can't help. Yeast is still possible, perhaps due to Candida glabrata (rather than the more common Candida albicans); glabrata does not respond well to the standard treatments. Or some sort of allergic reaction. There are several possible causes other than herpes, but I'm not an expert in this area. If or when you can afford it, consider asking your provider for referral to an ObG who subspecializes in infectious diseases. But in the meantime, don't worry about herpes. It's not the problem.
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