Please help, how could it be ...?

[vll970]

I was diagnosed with bacterial vaginosis almost two years ago and since then undergone multiple treatments. I was prescribed and treated with Metrogel at least 5 times. The problem would disappear and then come back as soon as after the first time I have sex. The discharge changes during the month from really bad to sort of OK, but in the worst time is thick, almost cottage-cheese looking and a bit smelly. It would cause some discomfort primarily during sex but not terrible...for me. My boyfriend on the other hand had suffered so much from it that we almost do not have sex anymore. The effects for him range from discomfort and redness, to little red spots, to severe blisters all around the shaft and on the head of his penis that look like acid burns. In addition, he develops cold-sore like little white pimples all around his mouth after oral sex.

I have talked to my OBGyn many times and she continues to just tell me it's a persistent form of bacterial vaginosis. She did a Ph test after I described the "acid burns" and said that on the contrary, it seems to be not acidic enough. How could this be? I have read a lot about the condition but couldn't find anything on similar effects on the male. I did however read up on someone who had a vaginal staph infection that seem to have some of the same effects. What should I do? What should I be tested for? Please help..

[H. Hunter Handsfield, M.D.]

Diagnosing, treating, and preventing recurrences of unexplained vaginal infections can be really difficult.  All I really can do is talk about about possibilities - but you're clearly going to need expert care.  It sounds like your ObG has average general knowledge, but probably not a particular expert in vaginal infections.  Most major medical centers these days, especially those affiliated with medical schools, have ObGs who have special expertise in infectious diseases--either self-taught or by formal training.  You should seek out such a person.



You give mixed messages about the likely cause, and might have (or have had) 2 or more separate problems.  Cottage-cheesy discharge and your partner's symptoms are strong evidence against bacterial vaginosis, which typically causes thin grayish discharge and no irritation/itching/rash in either the infected woman or her partner, and no discomfort during sex.  Those symptoms suggest yeast, which also might explain his oral symptoms after oral sex.  On the other hand, yeast does not cause strong odor--which is typical for BV or sometimes trichomoniasis.  But even a garden-variety ObG generally has no difficulty diagnosing yeast or trich.  You may well have BV plus yeast or something else, and/or might have had BV initially--but BV probably isn't the only problem now.



No woman's vaginal acidity is ever high enough to cause irritation or rash in a partner. That never happens.  Bacterial vaginal infections aside from BV are not common, but also not well studied.  The most common cause probably is streptococcus (usually "group B" strep); staph may do it, but is uncommon.



I need to mention the possibility of herpes, given some of your and your partners symptoms--but it's a long shot and I don't think is the main problem.



So ask your ObG about yeast and getting tested for it (not just with a microscopic exam, but with culture); or try one of the over-the-counter yeast meds.  But if that doesn't provide quick and complete relief, look for a specialist as I suggested above.  Or just look for a specialist now.  At that time, plan on going with your partner for simultaneous examination--especially if you have had sex recently and he has evidence of genital or oral inflammation.



Good luck--  HHH, MD

[monkeyflower]

First of all, is your bf also seeing HIS doctor about this?



However, I had almost the same thing happen to me, right down to your partner's symptoms. Unfortunately, I can tell you from experience that BV is really, really hard to get rid of; I had to go back to my doctor three times in one month before it was finally gone. The worst part was that my discharge seemed to burn pretty much anything it touched--his genitals, hands, my skin, whatever. Giving me oral gave him canker sores. What seems weird is that when you have BV the pH level in your vagina is more alkaline than acidic. Seems counterintuitive, given the burning sensation, doesn't it. Anyway, once I finally got rid of it, then all of his symptoms disappeared too :-)



However, I have to say that cottage-cheesy discharge doesn't sound like BV to me, more like yeast.

[vll970]

Thank you for responding so thoroughly. I have been having suspicions about the level of knowledge my doctor has. She seemed rather confused and kept reading up on medical articles on how to treat BV. She aslo never did a culture, just kept looking at it under a microscope which I found odd. Unfortunately, there are no other OBGs in the area. I just had one more question. Is it possible that this is a side effect of medication? I have been on Dostinex for the last few months after an MRI showed a pituitary micoadenoma. I know that certain antibiotics and other meds can cause a change in the vaginal balance. I also read somewhere about douching with lactic acid or soemthing of the kind to restore the natural environment. Is that an option? Thank you.

[H. Hunter Handsfield, M.D.]

Don't be too hard on your ObG.  She has the confidence to let you know that she doesn't have all the answers and to look them up rather than guessing.  It's often a sign of basic competence and quality care.



I'm not familiar with Dostinex, but I suppose it is conceivable it has an effect on vaginal physiology.  Your ObG should know something about it.



No woman should ever douche, whether for "hygiene" or any other reason, with lactic acid or anything else.  Douching does not effectively prevent or treat any infection, and it is a major risk factor for...[are you ready for it?]...bacterial vaginosis.  (It's also associated with pelvic inflammatory disease and infertility.) If you have been douching, stop; it might be part of you problem.  If you haven't started, don't.



HHH, MD