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Possible atypical herpes outbreak?
Good Morning,
1 1/2 months ago I developed a vaginal burning sensation after my period. The burning was intense and I had never had it before. I did not have any burning while urinating, it was only just a constant burning more related to my skin not internally. I also had abdominal pain and pressure which lasted after my period. After my period ended I had a watery mucus like discharge which was unusual. I went to my gyno (first available appt) who inspected and thought that I may have a bacterial infection so I was prescribed Metrogel. An STD panel was run and everything was negative except for HSV1. I did not have a UTI. I used Metrogel vaginally once a day for 7 days. The burning subsided. About a week later I developed bilateral inner thigh pain 1/2 way between my groin and knee. That pain then turned into a strong burning sensation. My legs were hot to the touch, but there was no visible rash. I then started having pain when sitting down. If I sat for a long period of time my legs would begin to tingle and feel like pin pricks. I got my period again and on day 4 the vaginal burning came back and then suddenly my whole vaginal area swelled and became red. The burning became so intense, I couldn't think. I applied hydrocortisone cream that to the outervaginal area 3 times. Within 12 hours the burning and redness had subsided. I went back to my gyno. I also asked about the discharge because again I was having heavy discharge after my period which was not normal. She said it was nothing. I have had this heavy watery discharge for 2 weeks after my period and it is finally subsiding. However, I then started noticing blood after wiping. I inspected anally and found two oblong almond shaped red fissures? I have a very mild tingling/burning sensation around my anus, but this could be from my heavy discharge? I have had these fissure type cuts before in the past, but thought nothing about them. Would you provide me with your thoughts? Thank you.
1 1/2 months ago I developed a vaginal burning sensation after my period. The burning was intense and I had never had it before. I did not have any burning while urinating, it was only just a constant burning more related to my skin not internally. I also had abdominal pain and pressure which lasted after my period. After my period ended I had a watery mucus like discharge which was unusual. I went to my gyno (first available appt) who inspected and thought that I may have a bacterial infection so I was prescribed Metrogel. An STD panel was run and everything was negative except for HSV1. I did not have a UTI. I used Metrogel vaginally once a day for 7 days. The burning subsided. About a week later I developed bilateral inner thigh pain 1/2 way between my groin and knee. That pain then turned into a strong burning sensation. My legs were hot to the touch, but there was no visible rash. I then started having pain when sitting down. If I sat for a long period of time my legs would begin to tingle and feel like pin pricks. I got my period again and on day 4 the vaginal burning came back and then suddenly my whole vaginal area swelled and became red. The burning became so intense, I couldn't think. I applied hydrocortisone cream that to the outervaginal area 3 times. Within 12 hours the burning and redness had subsided. I went back to my gyno. I also asked about the discharge because again I was having heavy discharge after my period which was not normal. She said it was nothing. I have had this heavy watery discharge for 2 weeks after my period and it is finally subsiding. However, I then started noticing blood after wiping. I inspected anally and found two oblong almond shaped red fissures? I have a very mild tingling/burning sensation around my anus, but this could be from my heavy discharge? I have had these fissure type cuts before in the past, but thought nothing about them. Would you provide me with your thoughts? Thank you.
MEDICAL PROFESSIONAL
Your own doctor has obviously considered PID and her opinion about it, or perhaps additional tests, will be more accurate than anything I could say. You might ask her whether she is certain the cysts were not due to PID, however.
Gonorrhea and chlamydia tests are very good, but not perfect. It is possible you had one of those missed by the tests, but not very likely.
Your sexual history indeed makes a new STD (like gonorrhea, chlamydia, etc) less likely -- unless your partner has had other partners recently. You are a better judge of that possibility than I can be. As for herpes, most new cases are acquired from partners who have HSV-2 but don't know it; and in the US around 20% of all persons have asymptomatic HSV-2 infection. However, the symptoms of a new HSV infection usually start within a few days of exposure -- so most likely this history rules out herpes as well.
Gonorrhea and chlamydia tests are very good, but not perfect. It is possible you had one of those missed by the tests, but not very likely.
Your sexual history indeed makes a new STD (like gonorrhea, chlamydia, etc) less likely -- unless your partner has had other partners recently. You are a better judge of that possibility than I can be. As for herpes, most new cases are acquired from partners who have HSV-2 but don't know it; and in the US around 20% of all persons have asymptomatic HSV-2 infection. However, the symptoms of a new HSV infection usually start within a few days of exposure -- so most likely this history rules out herpes as well.
Dear Dr. Hansfield,
I forgot to add that I also had a pelvic ultrasound completed. I was told everything was normal except that I have multiple cysts on both ovaries. This was completed about 1 week after my period. I don't know if this matters, but thought I would let you know.
I am also uncretain about how this could be a new HSV2 infection if it is. I am in a managomous relationship and I hadn't had intercourse for over one month before the symptoms arrived.
Thank you again and I am sorry to keep posting. I will not have any more posts until I come back with a diagnosis!
I forgot to add that I also had a pelvic ultrasound completed. I was told everything was normal except that I have multiple cysts on both ovaries. This was completed about 1 week after my period. I don't know if this matters, but thought I would let you know.
I am also uncretain about how this could be a new HSV2 infection if it is. I am in a managomous relationship and I hadn't had intercourse for over one month before the symptoms arrived.
Thank you again and I am sorry to keep posting. I will not have any more posts until I come back with a diagnosis!
Dear Dr. Hansfield,
Thank you for your response. All of my STD tests came back negative (except for HSV1) including chlamydia and gonorrhea. Is it possible that the tests might have been incorrect for chlamydia and or gonorreha- do you believe I should retest for those?
I am going to print out what you wrote and take it back to my doctor. Thank you for the advice. I have read that it is difficult to diagnose for PID. What would you recommend my doctor check for?
I will let you know what my diagnosis is if I get one.
Thank you again.
Thank you for your response. All of my STD tests came back negative (except for HSV1) including chlamydia and gonorrhea. Is it possible that the tests might have been incorrect for chlamydia and or gonorreha- do you believe I should retest for those?
I am going to print out what you wrote and take it back to my doctor. Thank you for the advice. I have read that it is difficult to diagnose for PID. What would you recommend my doctor check for?
I will let you know what my diagnosis is if I get one.
Thank you again.
MEDICAL PROFESSIONAL
Welcome to the STD forum. I'll try to help.
Herpes is a possible explanation for your symptoms, but they are not typical for that diagnosis. As it happens, I just finished a rather lengthy explanation of why many education resources say things like burning, tingling, pimples, back pain and other symptoms are caused by herpes and yet most people with those symptoms don't have herpes. Those comments refer primarily to skin lesions like pimples, but the principle is the same: herpes is almost always typical in appearance and natural course; it is "atypical" only in retrospect. Another principle is that "atypical" herpes is usually typical but mild. See the discussion at http://www.medhelp.org/posts/STDs/Acne--folliculitis--herpesdont-know-what-to-think-despite-two-negative-blood-tests/show/1076077
With symptoms like this, I would be concerned about a yeast infection. Yeast infections are easy to miss on standard testing, and I suggest you ask your doctor about trying an anti-yeast treatment even if testing didn't show that diagnosis. I'm also concerned about things like chlamydia and gonorrhea, especially with the "abominal pain and pressure" (maybe pelvic inflammatory disease [PID]?). Trichomonas also is possible. As for a "bacterial" infection, the most common such problem is bacterial vaginosis, and that is what Metrogel is used for -- but BV generally doesn't cause soreness, itching, or redness.
Having said all that, I cannot guarantee you don't have a new genital HSV infection. If so, it is probably due to HSV-2; your positive HSV-1 result probably is unrelated to any of this. It is possible that the blood test was done too soon to detect HSV-2 antibody, which takes a few weeks to develop. Therefore, you should speak with your doc about repeating the HSV-2 blood test to see if it has become positive since the first one. But my bet is that it will remain negative, that something else is responsible.
I hope this helps. You might consider printing out this reply and discussing it with your provider. If and when a definite diagnosis is established, please return and let me know.
Good luck -- HHH, MD
Herpes is a possible explanation for your symptoms, but they are not typical for that diagnosis. As it happens, I just finished a rather lengthy explanation of why many education resources say things like burning, tingling, pimples, back pain and other symptoms are caused by herpes and yet most people with those symptoms don't have herpes. Those comments refer primarily to skin lesions like pimples, but the principle is the same: herpes is almost always typical in appearance and natural course; it is "atypical" only in retrospect. Another principle is that "atypical" herpes is usually typical but mild. See the discussion at http://www.medhelp.org/posts/STDs/Acne--folliculitis--herpesdont-know-what-to-think-despite-two-negative-blood-tests/show/1076077
With symptoms like this, I would be concerned about a yeast infection. Yeast infections are easy to miss on standard testing, and I suggest you ask your doctor about trying an anti-yeast treatment even if testing didn't show that diagnosis. I'm also concerned about things like chlamydia and gonorrhea, especially with the "abominal pain and pressure" (maybe pelvic inflammatory disease [PID]?). Trichomonas also is possible. As for a "bacterial" infection, the most common such problem is bacterial vaginosis, and that is what Metrogel is used for -- but BV generally doesn't cause soreness, itching, or redness.
Having said all that, I cannot guarantee you don't have a new genital HSV infection. If so, it is probably due to HSV-2; your positive HSV-1 result probably is unrelated to any of this. It is possible that the blood test was done too soon to detect HSV-2 antibody, which takes a few weeks to develop. Therefore, you should speak with your doc about repeating the HSV-2 blood test to see if it has become positive since the first one. But my bet is that it will remain negative, that something else is responsible.
I hope this helps. You might consider printing out this reply and discussing it with your provider. If and when a definite diagnosis is established, please return and let me know.
Good luck -- HHH, MD
You are reading content posted in the STDs Forum
Herpes spreads by oral, vaginal and anal sex.
Herpes sores blister, then burst, scab and heal.
STIs are the most common cause of genital sores.
Millions of people are diagnosed with STDs in the U.S. each year.
STDs can't be transmitted by casual contact, like hugging or touching.
Syphilis is an STD that is transmitted by oral, genital and anal sex.
