Question: I am a 25 year old sexually active woman. I've suffered recurrent bouts of increased frequency of micturition with occasional burning sensation, white vaginal discharge and itching of the vagina. I have treated myself with either of fluconazole 150mg (singe dose) or ofloxacin (5 days) or both one after the other if the symptoms have not stopped. However, I have had two episodes of excessive vaginal discharge in which oral medication did not cure the symptoms. The first time, I took fluconazole twice ie on day 1 and then day 3 since the onset of symptoms but it did nothing. Then I switched to candid cl vaginal suppositories for three consecutive nights which resolved the issue. The second bout of severe discharge with mild itching started about a month ago. I took oral fluconazole and started candid cl. But 14 hours after using the second suppository, I engaged in intercourse. The discharge did not disappear after completing the regimen so I repeated the three-consecutive-day course of candid cl after which I engaged in intercourse again. I then noticed a small 1cm tear/wound on the 13th of December right below the vaginal opening in the soft tissue which caused some pain during intercourse. Since then I have abstained. I started menstruating on the 17th till 22nd. I noticed some discharge again today. There are no other symptoms. The wound looks like this - centrally depressed area with discoloration( it looks like the color faded) and surrounding area is a little more pink than the normal vaginal tissue.

There is no pain in the wound. The discharge is white, moderately foul smelling and it comes from the vagina. Please tell me if the wound will heal by itself because it has been there for almost two weeks now. Find attached pictures

I have uploaded the picture, kindly advise

I got the swab done, the result is neisseria gonorrhoea, I have uploaded the culture sensitivity reports as well. Kindly advise further

Thank you doctor. I have a few more questions --

1. Does the '--' signify that the antibiotics having not been used on the organism in this test or does it signify that the tests weren't conclusive?

2. I'm extremely disturbed about the fact that this strain has developed resistance to all the antibiotics routinely used for this disease maybe because I self medicated for months without getting a culture/sensitivity done. Does the oral medication you prescribed ensure complete eradication?

3. What work-up should I ask my partner to get done and how should he be treated if he's infected?

4. How do I prevent this from recurring in future?

5. Do you think it is necessary to take medication for a possible chlamydia infection as well?

6. When should I get a repeat culture/sensitivity done?

7. My wound seems to have decreased in size but I cannot be sure of it. There is no pain or discharge from it. I'm enclosing a picture. Please find attached.

8. Foul smelling discharge from the vagina persists but has decreased as compared to when it began.

Kindly advice. Thank you for your time.

Hi, I have provided some attachments. Please review them.

Queries:

1. I uploaded the latest lab report and a pic of the ulcer. The lab had said that they have a basic set of tests they do for gram negatives hence they didn't test the other antibiotics. However, when I requested them they tested a few of the other drugs shown in the report. Also, I visited an ObGyn and he told me to take Amoxycilin and clavulinic acid tablets 6hourly for 10 days and metronidazole(400) tds for 5 days. I'm a little confused because you had said 12hourly for 7days. I don't want to abuse antibiotics since the strain is already resistant. Help?

2. I've been with my partner for 9 months now. My partner is apprehensive about getting his urethral swab done because he thinks it will cause him pain. He is still asymptomatic. But because I have not had any sexual contact in the past 2 years outside my current relationship with my partner, I do not know where else I could have got it from. It is essential to get him tested, isn't it? He has had 4 sexual partners before me in the past 5 years, two of whom he was sexually active with at the same time for a few months. While he was seeing his partners, none of them had any symptoms that he knew of. Naturally, it didn't even occur to him that something could be wrong till I started showing symptoms.
My symptoms started the first time he ejaculated in my vagina(8 months ago) after which I had taken an ECP. Also, the first episode or oral sex had caused painful red elevations at the back of my throat which I thought was candidiasis and treated with fluconazole. It healed in 3 days and I've never had anything like that since.

3. My partner and I have abstained from any kind of sexual contact since 18th December. Is it safe/advisable to engage in the same using condoms?

I hope I've explained everything rightly. Kindly advise. Thank you.


One more thing, I've reported a problem I'm having with uploading pictures or reports but no action has been taken yet. The minute I upload something, every other attachment gets overwritten by the current picture/report. Currently I'm uploading the revised C/S report. I'll upload the picture of the ulcer w hen you've checked this one.

Hi doctor,

My partner and I engaged in vaginal intercourse using condoms. On the third occasion, I experienced some mild burning sensation at the ulcer site when I was washing up afterwards. Will the ulcer heal on its own or do I need to use some topical medication on it?

We are waiting on my partner's urethral swab reports. We shall upload the same once we get it.