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Suggest treatment for vaginal itching and vaginal discharge after intercourse

Answered by
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Dr. Timothy Raichle

OBGYN

Practicing since :1999

Answered : 1686 Questions

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Posted on Mon, 16 Mar 2015 in General Health
Question: I went to my ob-gyn due to vaginal itching. She did a pap smear and told me I had HPV. She also said she saw very mild warts (inside my vagina) and prescribed imodium. Months after she did two blood tests. The first time my ob-gyn said it wasn't HPV, instead it was HSV-1 (oral herpes), the second time she said she was wrong and it was actually genital herpes (she told me the antibodies were present in my blood). She prescribed valtrex and I suddenly came down with extreme dizziness, chills, and flu like symptoms. Initially I thought this was part of the first outbreak, but now I think it was side effects from the valtrex. I am worried because her diagnosis has not been consistent over time. In addition, I am not sure my symptoms fit. The primary symptoms I have is vaginal discharge about a week after having sex (no odor), something that feel and look like small paper cuts in my vaginal area, and I've noticed before and after the discharge period, the skin on the inner parts of my vagina are discolored (white). I have not seen any warts (and I am still not really sure if I had them the first time), no blisters or bumps that rupture, have fluid, or scab. I know people can be asymptomatic, but my partner has had no symptoms. ON the other hand, none of these symptoms started until I had sex with this partner about a year ago. I do not experience any of the symptoms I mentioned unless I have sex. I am considering having blood tests done again, but it is costly. I have already spent a bit of money investing in holistic remedies, but if I have an infection of some sort in addition or in lieu of herpes, I would like to figure this out. I am reading far too many stories of false positives and alternative diagnosis (i.e. thrush, trichomoniasis, etc.) that can be mistaken to feel confident in my doctor's diagnosis. Any advice would be appreciated.
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Answered by Dr. Timothy Raichle 53 minutes later
Brief Answer:
Herpes, HPV, and other vaginal infections possible

Detailed Answer:
Thank you for the question. First, I want to break this down a little bit:

1. You were seen for vaginal itching - this is most likely related to a yeast infection
2. You had a pap smear with evidence of HPV - this would imply that the pap smear was abnormal. HPV is a virus that you are exposed to because you have been sexually active. It is very common. As you know, it causes pre-cancerous changes of the cervix and genital warts. She may have seen warts inside of the vagina, but this sounds uncertain. But, it is certainly possible that HPV changes were present on the pap smear
3. You had blood tests that indicate you have been exposed, at some point in the past, to the herpes virus. HSV1 usually causes oral sores, and HSV2 usually causes genital sores. But, you can get HSV1 in the gential area and HSV2 in the oral area too.
4. Herpes outbreaks would not occur consistently every time you have intercourse - so the consistent, recurrent symptoms with intercourse is something else.

Here is now what I think:

REGARDING HSV:
1. If you had blood tests indicating prior exposure to herpes, then you have been exposed to the herpes virus and retesting is, in fact, a huge waste of money
2. HSV1 involving the genital area is associated with infrequent outbreaks. Women can go years without recurrent problems.
3. While a primary outbreak of herpes is associated with a flu-like illness, it is also associated with a classic outbreak of blisters that are painful - this did not happen, so the illness you described and the timing do not fit with herpes

REGARDING HPV:
1. We have all been exposed to HPV virus if we have been sexually active
2. You need clarification of the pap smear abnormality and whether this requires followup testing
3. Genital warts can occur in the vagina and would be hard for you to see, but your doctor sounds incompetent in terms of being able to clarify just about anything, so I would not trust their impression

REGARDING PAIN WITH INTERCOURSE / ITCHING / VAGINAL TEARS:
1. In the setting of mildly inflamed vaginal tissue, it would not be suprising for intercourse to lead to small tears.
2. The question is, what is it about the vagina that is made worse by intercourse. Your clues are itching and an adherent white discharge. You may have a low-grade chronic yeast infection made worse after intercourse
3. Also consider a reaction to lubricants, condoms (latex)
4. Also consider vaginal dryness / predisposition to yeast infection that can be caused by being on low-dose birth control pills

HERE IS WHAT YOU SHOULD CONSIDER:
1. Get a new OB/GYN - your current one has not done you any service with their unclear explanations of anything.
2. Forget holisitic remedies - you are just wasting additional money on treatment that will not work
3. Consider daily Valtrex (500mg per day) for a few months to suppress any concerns that this might be related to herpes - and to avoid any confusion
4. Ask your new doctor to perform a culture for yeast
5. Ask your new doctor for a prescription for diflucan - an easy, oral way to treat yeast infections
6. If you are on a birth control pill, ask your new doctor if they think that this is contributing in any way to your current problem

I hope that this helps!
Dr. Raichle
Above answer was peer-reviewed by : Dr. Vaishalee Punj
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