Trich/ Herpes/ Yeast?

[Cat82]

I went to the gyno seven days ago complaining of a "dryness" around my labia, as well as a painful red rash along my perineum. The rash does not appear with bumps, but rather looks like a small weepy cut right below my vaginal opening with an accompanying red ring. I also have a swollen/ tender perineum. The flow of urine over the area is very painful, and I have since started to experience some pain around my anus that feels like small cuts.  I have experienced some diarhea lately, which I believe is the result of the medicine she put my on.  When i have looked in the mirror, i have also seen some white discharge running down into the rashy region.

So she said these syptoms could also be caused by a bad yeast or bacterial infection (which a culture test revealed I had... in fact, she said it was a real bad case).  However, she also mentioned that it looked "suspicious" of HSV and took a test ( was also tested for everything else and am awaiting results... did come back HIV negative though) .   In the meantime She put me on metronidazole for seven days as well as tetrazol and Valtrex (to be "safe"). I have had unprotected sex so all of the above are possibilities.  

Basically, I have finished the metro and tetra and still have a couple days of Valtrex left.   There is less pain (it was real bad for a couple days), but symptoms are still present and the red area is still looking "weepy" and feeling swollen.  If trich, yeast or HSV were the culprit would it be typical for symptoms to still be present despite the meds?  Can this possibly be tied into the pain around my anus and new bacteria from stool entering into the rashy/cut region?  I still have the dryness as well.  Are there any indicators that would set diagnoses of a bacterial or yeast infection apart from HSV?   Also worth noting, I got drunk one night before this occured and wet the bed... not sure if this could have cause this chain of events.  

Please let me know your thoughts!

[help201068]

A related discussion, trich and herpes are they related? was started.

[Edward W Hook, MD]

I'm sory to hear that things turned out this way.  I know you had hoped otherwise.  On the other hand, thanks to your doctor's careful approach, you now have the knowledge of your infection and thus can make decisons regarding how to deal with it.  In the U.S. most people with HSV do not know it and thus are at risk for all sorts of problems, including unknowingly spreading it to others.  You can explore treatment options.

It is difficult to estimate about the situation you describe.  In general, it takes about 5-7 days after exposure for lesions to appear and the infection to become contagious.  After that, most transmission occurs through asymptomatic shedding (that is the virus is present on your skin with lesions).  At this juncture, you might find a book called Living With Herpes by Charlie Ebel and published by the American Social Health Association very useful.  Many of my patients have found it very helpful.  You can find it on their website.  EWH

[Cat82]

Thank you... I received my results and unfortunately, I tested positive for type 2.  This leads me to another question... how quickly does the virus spread?  For instance, if I acquired it from one person and had unprotected intercourse one or two days later with another person, what is the chance that it was passed on (at this time there were no signs)?  Is there a period of latency?

[Edward W Hook, MD]

As I read your description I found myself coming up with the same thoughts as you GYN and agree with the therapies she chose.  Indeed, as she suggested some of these do co-exist from time to time as well.  On the therapy you are on, I would have anticipated that now (I estimate its about 7 days later) each of the problems she is treating you for would have begun to improve.  Is there no improvement?  Sometimes some of these problems are slower to respond than others.  

Several other thoughts occur to me as well, given what has transpired since you started therapy.  One is that if your have a yeast infection, on occasion yeast are resistant to terazol and/or being on other antibiotics can slow response to therapy so there may be a need for re-treatment, particularly now that you are off the metronidazole.  Another possibility is that your original illness(s) may have been replaced by a drug rash.  

I agree that your diarrhea may be due to the antibiotics, as may your anal discomfort.  As the other processes get better, these should to.

In any case, my advice is to let your GYN know that you are no better.  In medicine, sometimes one problem evolves of leads to another.  Odds are that there are more test results back now and a repeat examination by a trained observer (your GYN) may help to sort things out.  The approach she has taken so far certainly sounds logical to me.  

Hope this helps.  EWH