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Treatment resistant discharge
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The STD Forum is intended only for questions and support pertaining to sexually transmitted diseases other than HIV/AIDS, including chlamydia, gonorrhea, syphilis, human papillomavirus, genital warts, trichomonas, other vaginal infections, nongonoccal urethritis (NGU), cervicitis, molluscum contagiosum, chancroid, and pelvic inflammatory disease (PID). All questions will be answered by H. Hunter Handsfield, M.D. or Edward W Hook, MD.

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Treatment resistant discharge

I have had vaginitis for over a year now - I've seen my OB/GYN many times and sometimes she's said the discharge looks like yeast, sometimes it looks like BV - she thinks it's probably a combination of both. All tests for Chlamydia, Gohorrhea, and Trich have been negative, and of course my PAPs are normal. All other blood tests - sugar, HIV, immune function, CBC, syphilis, hormone levels have been normal. I also had an internal and external pelvic ultrasound - normal. It started after a course of Zithromax for a nasty tonsillitis (prior to that I'd had protected sex one month before and unprotected sex - the only time in my life - six months before). The discharge is white, VERY profuse and pasty except at ovulation when it's the consistency of water, foamy, and bright yellow (I have to change pads about 4 times a day it's so profuse). It's also incredibly painful - itchy, burning and irritating and if it sits on the labia for any length of time it causes painful ulcerations (which we cultured - neg. for herpes). It has been completely un-responsive to both oral and vaginal medications, including: Clindamycin oral, Clindamycin gel, Terconazole, Clotrimazole, Butoconazole, Diflucan, Metro-Gel, birth control pills (my dr. says these can help BV but make yeast worse), acidophilus suppositories and even 650mg of Boric Acid topically for up to 2 months! I eat VERY well, (no junk food, refined food, or sugars), and take lots of acidophilus/eat yogurt with live cultures. My gynecologist is stumped - we've cultured the discharge and it's been neg. for anything at all (although I had just treated vaginally with Terconazole less than 24 hrs prior to the culture). She says it's not nec. to repeat the culture, and can't think of anything else to do - we don't even know what kind of specialist would take these kinds of cases - has anyone ever heard of this? Are there any other treatments or tests I can discuss with my dr.? Are there physicians that specialize in cases like this? I called local hospitals/med. centers and they don't seem to have specialists that have seen this kind of thing.. And is there a possibility that there's an underlying STD causing all this? Are false negative test results possible? I know this is a very difficult case, but any advice you can give me will be appreciated, I will then in turn discuss it with my gynecologist. (Oh, also, I have a history of 1 yr. antibiotic use 5 yrs ago for Lyme, and about 2 UTIs per year which we tx with Cipro). Thank you!
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I would like to help, but it really is impossible for anyone to make a reliable judgment by online description after several health care visits, tests, and treatments haven't come up with a clear answer.  Persistent, unlexplained vaginal discharge is a common problem, and even in expert STD clinics, we often run up against the same blank wall where you and your providers find yourselves.  You can be very certain it isn't any known STD that is causing the problem.

The only thing that comes to mind, that might or might not have been investigated, is infection with an azole-resistant yeast, such as Candida glabrata (as opposed to C. albicans, which generally is senstive to the drugs you have had).  Also, if not done, you could request referral to an ObG who also is an infectious diseases specialist.  Although not common in all communities, such specialists generally can be found at academic medical centers.  Although I do not make online referrals to particular specialists, if you tell me what larger cities or academic medical centers you are near, I might be able to provide general guidance.

Sorry I can't help more.  Good luck--  HHH, MD
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