Vulvodynia or STD????

Dear Good Doctor,
Thank you so much for your contribution to this site.
Sorry this is long, but I'm so confused and becoming very depressed from my condition. I wrote a few weeks ago but I'm still having symptoms and need advice.

I'm 36 yo female, married 15 years - I did a very stupid thing and had a one-time sexual affair with a close friend of mine. We had protected intercourse, but prior to the intercourse, I remember grabbing and rubbing my friend's penis (there may have been some pre-ejaculate) and he was fingering my vaginal area followed by some mutual masterbation (masturbation) before he put a condom on.

About a month after this encounter, I began experiencing burning and itching in the vaginal area and burning and frequent urination with some discharge (no odor). It's almost like my vagina has a "cold". (I have had HSV-II for many years and these symptoms are different than the symptoms I have during an outbreak). My friend swears he is clean, but he is recently divorced and very promiscuous.

To write the shorter version of a very long story, I have been to see a Nurse Practitioner (from the OB/GYN dept of my HMO) four times in the last 6 weeks and I'm still having the same symptoms as mentioned above.

Here's the problem: During my first visit, the NP thought I only had a bladder infection and gave me Nitrofurantoin.  I went back to see her a week later (while still on the Nitrofurantoin) because I was still having the same symptoms. She did a vaginal culture and screened me for all STDs. The results were negative.  A week later I was still having symptoms, so I went back. The NP said there was no reason to do another vaginal culture and said I probably had a yeast infection. She gave me a one-time dose of Diflucan (sp). Two weeks later, I went back again because I was still having the same irritating symptoms. I insisted on another vaginal culture, but the NP refused to give me one. She said even though I was taking the Nitrofurantoin during my vaginal culture, it wouldn't change the results of the vaginal culture, and I had no infection; therefore, there was no reason for another culture. She gave me Nystatin and Traimcinolone topical cream and told me to use it twice a day for seven days - which I have  - and guess what?? I'm still having these terrible symptoms!!

I'm so confused and depressed over this. I didn't think you could get an std from fingering and hand-to-hand contact, but I don't know what else these symptoms could be. I've been avoiding sex with my husband for fear I have some disease that they didn't pick up.

My question is, with the limited exposure I had and the negative vaginal culture (while taking Nitrofurantoin) am I overreacting here and is my NP correct in assuring me there is nothing wrong (no infection)? It's hard not to react when I'm having these symptoms. If there is no infection, could this be "vulvodynia"? Is there such a thing?

Thank you very much for any information.

[H. Hunter Handsfield, M.D.]

Unfortunately, I doubt I can be very much help.  Vulvodynia indeed is frustrating, but whether that is the correct diagnosis or not I cannot say. An active STD, at least of the traditional type (chlamydia, gonorrhea, herpes, etc) seems unlikely and presumably the NP has checked you for common vaginal infecitons (yeast, trichomonas, bacterial vaginosis).  In additio to the negative STD tests to date, to have further comfort about absense of STD you could affirm with your partner/friend that he doesn't have anything, and if in doubt, ask him to be tested.  But I doubt that's the explanation, and I'm not at all sure your symptoms are related in any way to the sexual encounter you describe.  Perhaps the next step should be to see a gynecologist per se, i.e. the next step up the scale of expertise from the NP.  If available in your community, you might specifically request referral to an ObG who is especially interested and/or trained in infectious diseases.

Sorry I cannot come up with anything more specific, buy vulvodynia really isn't my area of expertise.  Good luck--  HHH, MD

[monkeyflower]

Sure, vulvodynia exists. In fact, there's a whole subset of gynecology devoted to pelvic pain - and while pelvic pain specialists aren't always that easy to find, evidently it's well worth the effort.

However, did the NP test you for BV? That's what your symptoms sound like to me. And did she test for any STDs? Anyway, I think if it were me, I'd go back (maybe to a different doctor, since she seems unwilling to consider any other possibilities), and get thoroughly checked out. Good luck!

[promiseandpray]

I have many questions, but my first is will amoxicyllin 875mg 2x day for 10 days eliminate an STD?  The story is very long, but I would like to start here.

Please say yes....