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veryworried posted:
So I recently came down with a sore throat, that continued for several weeks. I went to the Dr and he said it is just a virus, let it run its course. The rapid strep test was negative also. So about 3 weeks into having this sore throat I finally had enough and called the Dr. He gave me antibiotic for it finally. That same day I have a pain when I wipped and then noticed I had a sore down there. It looks just like a canker sore, red around the edges and whiteish in the middle. It doesn't hurt unless I wipe or touch it. Today after the bathroom I wipped and noticed a tiny spot of blood and whiteish colored discharge from the sore. The white area is now gone and it is just a shallow sore. It hurts some now but really only when I have to urinate. I tried getting into my Dr but they would not see me. I am terribly worried about. I have been researching and read that a partner can give you herpes from oral sex if they have a cold sore at the time. My husband and I have been together 5 years and are monogamous. He did have a cold sore a while back by his lip but I don't know if that would really have anything to do with this or not. He did perform oral sex on me so obviously this looks like a legit diagnosis to me but I am worried sick and cant get in to the dr. Can anyone help me?? Is it to do with the recent sickness or is it from his cold sore? So confused!
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Jane Harrison Hohner, RN, RNP responded:
Dear veryworried: Yes, it MIGHT be herpes simplex virus, and it COULD have arisen from oral sex from a partner with an oral herpes lesion. Another herpes possibility would be, if you or he have ever had another partner, that you could be experiencing an actual genital herpes out break. In this scenario, a very mild initial outbreak that went undetected is reappearing again due to your virus-weakened immune system. In both these instances the use of a prescription antiviral pill would be the treatment of choice.

Another POSSIBILITY might be a bad vaginal yeast infection which has created an open break in the skin. The antibiotics can make yeast more likely. Yet you have not noticed general vaginal itching

Given what you have shared my best GUESS would be a herpes lesion of some type--your symptoms sound classic for this. If you cannot get into your usual MD or GYN, you could try your local county family planning clinic. They may be able to work you in if you mention "initial herpes outbreak".

In Support,
Jane
 
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veryworried replied to Jane Harrison Hohner, RN, RNP's response:
I have been thinking a lot about this. I had what I thought was a possible yeast infection back on December 7 or a couple days before so I decided to treat it myself instead of going to the dr. I used some ketaconazole cream for a few days. It wasn't itchy down there but sore an I couldn't find any exact spots. I had what i thought Was my first yeast infection over the summer so i used monistat and vinegar/water rinses down there and it went away. Looking back I know the dr was a better idea but I didn't think it was serious an it was right after my period. Then a couple weeks, maybe a week later I started with my sore throat I went to the dr on the 18th. That's when he did a strep test that was negative and he said its a virus. I continued with my throat some days hurting worse than others until I finally called on the 31st and told the nurse. I started cipro that day, I noticed the sore down there the day before this. And I can not remember when my husband and I had oral sex and if he even had a cold sore when we did. So could it just be a sore from a yeast infection? It really isn't burning except to uninterrupted and it feels soft and isn't crusted over yet.
 
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veryworried replied to Jane Harrison Hohner, RN, RNP's response:
I went to same day care today. The Dr checked me out and said it did not look like herpes. I asked many questions and had him go ahead and swab it anyway. He said since I have had oral canker sores (inside my lips by my gums) also recently it could also be Behcet's disease. He did not give me any antivirals to take but did prescribe Kenalog to "roll" onto the lesion. Does this sound right to you? I am still unsure. The culture takes about a week to come back so of course I will worry like crazy until I hear something. This is so awful. I wouldnt wish this on anyone, ever!! I don't know what to do with myself until the test comes back!
 
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Jane Harrison Hohner, RN, RNP replied to veryworried's response:
Dear veryworried: Actually having someone visually examine the lesion and even do a HSV culture despite the fact that it did not appear to be herpes is good news. It sounds like you had a good work up where the MD thought of many possible conditions causing vulvar ulcers. For the benefit of other readers here is a link to more about Bechcet's disease:

http://www.niams.nih.gov/health_info/behcets_disease/

As you can note, if this is Bechcet's disease, the use of a steroid cream is the treatment of choice. I would urge you to do the treatment he prescribed. If the HSV culture does come back as a positive they will be sure to call you. As a clinician I can say that if a MD strongly suspects herpes they would have given you the anti-viral treatments the same day.

Thank you so much for the additional feedback. Your experience may help another woman with the same symptoms. Do let us know how things turn out, OK?

In Gratitude,
Jane
 
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veryworried replied to Jane Harrison Hohner, RN, RNP's response:
I suppose at this point I am just trying to reassure myself over and over but I started putting the kenalog or Triamcinolone oral base stuff on as he prescribed and the sore is not hurting at all, when I urinate I just lean far forward and pull the vulva away a little. I have been doing research on yeast infections and my symptoms sound similar to that as well although I am not itching or swollen down there at all. I keep wondering if possibly I need to ask for some diflucan to be sure it is not a yeast infection. I have been hoping since the sore is not bothering me that it will not be herpes but just a bad yeast infection. Do you think I should ask for a dose of diflucan, just to be sure? And have you heard about the candida spit test? Is this something that is even close to reliable? I noticed what I thought was some whiteish discharge inside my vagina last night when I was applying medicine. It is not odorous or clumpy at all. Just a whiteish clear thin drainage perhaps. Also I was wondering if I should have asked for some sort of antiviral just to be on the safe side in case the HSV swab comes back positive? Or just leave it alone, apply Triamcinolone Oral base and wait for the results?
 
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veryworried replied to veryworried's response:
Okay, I am still researching because I want to know the ins and outs of everything I may be facing. I have read it is rare now days, but what about chancroid sores? How likely could this be what I have? The sores sounds similar to mine and it says it could be transmitted through a scratch. I know my husband has not been with anyone else but it is possible for him to have had it on his hands, or in his mouth and passed it to me if I had a scratch? I suppose anything is possible and i am just trying to amake myself feel better but I dont have any muscle aches or pains, flu like symptoms, fever or anything besides the sore associated with herpes. I don't know...any insight?
 
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Jane Harrison Hohner, RN, RNP replied to veryworried's response:
Dear veryworried: Chancroid sores are VERY uncommon in the US. Especially given your history of a monogamous relationship I would really doubt this is the culprit. For other readers, here is a link to more information about this cause of genital ulcers:

http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0001659/

In terms of yeast, I would hope and suspect that the urgent care MD ruled out a marked yeast infection during your clinic visit. A simple test with a slide and microscope is all that is needed. A saliva test is not standard of care for diagnosing vaginal yeast infections.

Usually, in an ER or urgent care setting, if the examining MD strongly suspects a specific condition (eg herpes, yeast, etc) they will begin "empiric treatment" even before the return of pending lab tests. Thus it would seem that the steroid cream was chosen because neither yeast nor HSV was thought to be the the etiology.

Hope this ulcer subsides, and that your HSV test is negative.

Yours,
Jane


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