Urge to urinate, vulvar, anal and vaginal burning and fluid

[Monica2005]

I've had chronic genitourinary problems for the last 3 years.  My current symptoms are:

1.- Mild to severe vaginal, anal and vulvar burning, with burning around clithoris and urinary tract being the worse.

2.- I wake up at night (about 6:30 hours) after going to sleep to urinate, because of pain and burning.

3.- I have a moderate amount of white-yellow fluid coming from my vagina, which smells pretty acid (before it used to have a sweet smell)

4.- My clithoris area smells like fish (I isolated the smell with a Q-tip, since I didn't understand which smell was coming from where), and it didn't use to smell like that 4 months ago either.

Symptoms 2 and 3 have been going on for 3 years now (before the fluid didn't have a noticeable smell, but now it has).  I have been diagnosed and treated for chlamydia (azythrocin, tetracyclin, clindamicin) and candida (icaden-v, fluconazol, nizoral, vagitrol and micostatin-v) with no long-term improvement of symptoms.

Symptoms 1 and 4 have been going on for 6 months now.  I have been diagnosed with HPV (high risk ones in the PCR) and mild dysplasia a couple of months ago.  All my pap-smears (about 6 since this started) and colposcopys (2 since this started) came back normal before this.  My last normal pap was on Aug 04. For now I've used ovules and creams to treat the burning with only temp relief.

After being diagnosed with VPH I had a cryotherapy with no improvement on symptoms either.

I haven't been able to have sex with my boyfriend (plus I haven't been willing to) for the last 4 months because of the severe burning

please help me with the following:

1. from the burning and the fluid, should I be worrying about something else apart from HPV?  or could it be all due to HPV since the beginning (even if HPV didn't show up on tests for the first 2y)  

the lab tests I have had include:  cervical culture, chlamydia culture, mycoplasma detection, HIV, diabetes, tyroid hormones.

cervical cultures sometimes develop candida, and sometimes nothing just the doderlein bacile.  last one a couple of weeks ago came out with "faecalis" bacteria and nothing else.  I haven't taken treatment since that result.

chlamydia culture comes negative, but PCR came once positive (after a lot of negatives, and after the first positive).

mycoplasma, HIV, diabetes and tyroid problems have always come out negative.

2. what do you recommend I be doing other than to treat the dysplasia, to heal the terrible burning?

3. do you think the urinary urgency and pain is related to this, or should I be checking something else?  (my urine test and cultive have all come out normal)

4. I also have a mild sore throat on my right side since about 6 months ago which causes itching on my right ear.  Could this be related?  And how can I know?  And how can that be threated?

I've used this site before and your help has been incredibly useful.  Thanks again for letting us have this great service!

[Kevin Pho, MD]

To answer your questions:
1) You have been through a pretty thorough evaluation for diseases already.  Although it wasn't mentioned, I would also consider testing for gonorrhea as well.  

A transvaginal ultrasound is also recommended looking for any fluid collections or abscesses.

2) If the studies mentioned above are non-revealing, you can consider a cystoscopy to evaluate for an anatomical explaination for your symptoms.  

3) Tough to say without examination.  The cystoscopy and urology consult would be the next steps in evaluation.

4) Gonorrhea can cause the combination of STD-like symptoms and a sore throat.  Ensure that you have been tested for this.

These options can be discussed with your personal physician.

Followup with your personal physician is essential.

This answer is not intended as and does not substitute for medical advice - the information presented is for patient education only. Please see your personal physician for further evaluation of your individual case.

Kevin, M.D.
Medical Weblog:
kevinmd_b

[mistyjean444]

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[michellew]

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