Dr. Sameer Kumar
Obstetrics and Gynecology
The following is an actual conversation between an iCliniq user and a doctor that has been reviewed and published as a Premium Q&A.
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Patient's Query
Hello doctor,
I am a 21-year-old female. I have had recurring ulcers in my vulval and anal areas for the past four months. When it starts appearing, I can feel the itching. Then after a few days, they become painful. During and five days after my period, it clears out but comes back again after a few days. Also, I noticed that last month, even though my period was finished, I had cramps for a few days, which was new to me. My previous doctors prescribed me antimycotic, then various antibiotics, but they all did not work. Is this possibly herpes? My first sexual encounter was with my first boyfriend two years back and none until now, but it was only genital rubbing. My CBC is normal. I tested negative in VDRL, and my vaginal swab test was normal except for a high number of pus cells. I am scared. Please help.
Hi,
Welcome to icliniq.com.
I understand your concern.
I suggest you please send a picture of the lesion. It could be just folliculitis or possibly herpes zoster lesions.
Patient's Query
Hi doctor,
Thanks for your reply. When I had that encounter two years back, there was no penetration of any sort, only genital rubbing on the outer area. After taking my antibiotics capsule Doxycycline, tablet Co-amoxiclav, tablet Clindamycin, and tablet Neo-penotran, which did not work, I was prescribed a topical on my third outbreak Acyclovir cream to be applied once daily for a week. I applied for it for a week, but it did not heal. I did not get the chance to go back to the doctor since my period came and the lesions healed. This is my fourth outbreak, and they are starting to appear again. I am applying Calmoseptine Ointment because I observed that most of my lesions heal if I apply it. Ever since my first outbreak, I started using an obstetric antiseptic wash daily with warm water. I also do not use fabric conditioners on my underwear. Also, compared to my first outbreak, the pain and itching are significantly minimal. They are also much shallower now compared to before when it was crater-like. In my first and second months, the lesions were localized on the vulval area, but recently, some lesions grew near my anus. I do not know if this information would help, but I already had chickenpox and herpes zoster a few years later in my chest when I was an elementary kid. Please help.
Hi,
Welcome back to icliniq.com.
I understand your concern.
I have gone through the pictures and reports attached (attachment removed to protect the patient’s identity). The high vaginal swab reports confirm bacterial (gram-negative bacilli) infection bacterial vaginosis. The pictures showed candida infection with thick curdy white discharge from vaginal introitus and over the vulval area and candida sores or ulcers near the peri-vaginal and perianal area. I suggest you require treatment with anti-fungal and antibiotic pessaries for a week and oral antifungals and antibiotics for a week. This is not herpes zoster or molluscum contagiosum lesions (typical disc-shaped papules with central crater or dip).
I suggest you start with the following medications:
1. Clingen vaginal suppository (Clindamycin 100 mg and Clotrimazole 100 mg) for six days, it should be kept inside the vagina each night. By the following day, it will dissolve and then should be washed off with an alkaline vaginal wash.
2. Tablet Itraconazole 200 mg, 0-1-0 for five days.
3. Tablet Oflox 200 mg (Ofloxacin 200 mg) and tablet Ornidazole 500 mg,1-0-1 for seven days.
4. Tablet Pantoprazole 40 mg, 1-0-1 for seven days, consumed half an hour before taking food.
5. Tablet Flavoxate 200 mg, 1-0-1 for seven days.
6. Tablet Combiflam (Ibuprofen 400 mg and Paracetamol 325 mg), 1-0-1 for five days.
7. V-wash, 1-0-1 for ten days, should be used inside and outside the vagina.
8. Candida dusting powder, 1-0-1 for ten days for local application over the genital area and avoiding local moisture.
I suggest you follow this prescription and avoid intercourse or sex for the next three weeks.
I hope this helps.
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Obstetrics and Gynecology
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