Yeast Infection or Herpes?

[almostfamous89]

Here is a timeline (to the best of my knowledge):

Sept07 - March08: Almost constantly on antibiotics (amoxicillin, cephalxin, etc.) for pneumonia, strep, 2 UTIs and what was later diagnosed as Mono

Jan08: Unprotected sex with risky partner (he was my fourth overall, first unprotected) in mid-Jan; symptoms of UTI 2 days later, took antibiotics; few days after, had pelvic exam, nothing suspicous; same day as exam, developed itching/irritation in vulvar/anal area

February through April '08: Mid-Feb, finally diagnosed with yeast infection and oral thrush, used Nystatin and took Diflucan; symptoms diminished; during Y.I. noticed tear between anus and vulva; late Feb, given cephalexin for peritonsillar abcess, developed vulvar irritation again for a week before taking Diflucan, which went away; diagnosed with Mono late April; throughout this time period, I had 3 more pelvic exams which turned up nothing suspicious other than yeast.

Summer08: Mid-May, 2 unprotected exposures with trusted partner; Vulvar/anal irritation/itching begin early; unlike the spring, fairly consistent symptoms with no treatment; swimming almost daily for work, working out (I am a college athlete)

Aug-Sept08: Pap smear, results show ASCUS and yeast; use OTC antifungal, doesn't work; return for pel. exam, nothing abnormal except yeast, difulcan stops symptoms after second dose


I was diagnosed with strep last week and after taking Amoxicilian for a couple of days, I've noticed again symptoms that I've linked to a Y.I. for the past week. I usually feel irritation or itching during or after a workout. Whenever I have symtpoms, I check with a mirror. Until recently I checked almost daily and found nothing.Today I saw a small ulcer-like lesion between my anal/vulvar area. It becomes a bit irritated when I touch it.

Does this situation call for a herpes blood test, although I've been examined several times and have shown no visual symptoms? Can yeast cause such lesions?

Thanks.

[Edward W Hook, MD]

I cannot comment on the lesions whoever it is posible that they were yeast.  there is little else in your history to suggest herpes, at least that I was told.

If you want to be sure you should go on and have the blood test.  Make sure you are tested with a type specific test such as the HerpeSelect, it is a good test and there are many that are not very good. If you are going to have one however, as you enter this relationship so should he.  EWH

[almostfamous89]

Thank you very much for your response, it's quite helpful. If you could answer a couple more questions, that would be great:

So do you mean to say that the two lesions I've seen in the past 6 months or so are more likely related to my yeast infections than to herpes?

And I have a new boyfriend, so I want to be sure of my HSV status...and I know a blood test is the only way to be sure. I just need to know if, given my symptoms/history, if spending that much money on a blood test is practical.

Thanks again.

[Edward W Hook, MD]

There are really two issues in play here.  The yeast infection questions and the issue of a herpes test.  let's deal first with the yeast infection.

The multiple antibiotic treatments you have taken make you a set up for yeast infections.  We all have normal bacteria on our bodies which help to keep us from getting other infections.  When these bacteria are affected as a side effect of well intended antibiotic use, it creates an idea situation for yeast infections to occur.  (Put another way, nature abhors a vacuum).  When such yeast infections occur, they are most common in the throat (thrush), the vagina (in women) and the anus because these locations are where yeast normally are found, but are held in check by the normal bacterial present in those loations.  The antibitoics make you a set up for the yeast to overgrow, causing the infections yoiu have experienced.  In addition, as an athlete, between the moisture associated with working out, swimming, showers, etc, your risk is increased as yeast infection are more common in situations and areas which are moist.  Finally, just to make things even a little bit worse, because you have had multiple yeast infections, OTC medications for yeast may not work because of resistance evolving out of prior treatment.

The herpes issue is separate. there is nothing in your history to suggest you have herpes. If you were to get tested, you might find out that you have it, since about 9 out of 10 people with genital herpes do not know they have it.  Having said that , there is nothing is your history to suggest that your current problem is due to herpes.  If you got tested and found out you had HSV-2, it would not explain the problems you outlined in your question.

I  hope this all makes sense and is helpful.  EWH

[almostfamous89]

I also might add that only I have noticed the two lesions, the tear in February and the lesion today; none of the doctors in my ~6 pelvic exams have noticed anything, although I was having symptoms for at least half of my visits and informed them of my STD/HSV concern

[almostfamous89]

I thought I might add that when I do have symptoms, most of my irritation and itching is located in the anal area along with some sparse irritation in the vulvar region. Also, I tend to wipe pretty hard and sometimes I am not so gentle when examining myself...could this be a factor?