I am 20. Why am I having vaginal sores and discharge?

Hi,

Welcome to icliniq.com.

I have gone through your query and understand your concern.

I got your concern about vaginal itching with yellowish discharge. Based on the timing around menses, painful sores at the vaginal opening, dysuria from contact with sores, and malodorous whitish or yellowish discharge, the most likely scenario is a first episode of genital herpes with a concurrent vaginitis such as bacterial vaginosis (BV) or trichomoniasis.

Urgent in-person examination, swabs, and sexually transmitted infection (STI) testing are recommended to confirm and guide treatment promptly. Avoid sexual activity until evaluated and treatment is completed to reduce transmission risk to partners, because some conditions, such as Trichomoniasis and Herpes, are transmissible even without visible symptoms.

It could be possibly due to:

• Genital herpes (herpes simplex virus – HSV-1/HSV-2): Classically causes painful vesicles that ulcerate, burning with urination when urine contacts lesions, and can have first episodes that are prolonged and severe. Antivirals shorten symptom duration but do not eradicate the virus.

• Bacterial vaginosis (BV): Most common cause of vaginal discharge worldwide; typically thin discharge with fishy odor, often worse around menses.

• Trichomoniasis: Can cause yellowish, sometimes malodorous discharge and vulvovaginal irritation.

• Vulvovaginal candidiasis: Produces pruritus, soreness, and thick white discharge.

I recommend that you get the following investigations done:

• Physical exam with speculum: Document lesions and discharge characteristics, and perform bedside tests – vaginal pH, whiff test, and microscopy (saline and KOH) to distinguish BV, trichomonas, and candida.

• Swab from an ulcer for HSV NAAT or PCR (nucleic acid amplification test or polymerase chain reaction) or culture Vaginitis/STI testing: NAATs or validated panels for BV/trichomonas/yeast, where available. BV can also be diagnosed by Amsel or Nugent. NAATs for chlamydia and gonorrhea Serology for syphilis (RPR – rapid plasma reagin with treponemal confirmation), and HIV testingUrinalysis must be performed to exclude concurrent urinary tract infection (UTI).

• Pregnancy test to guide medication choices when treating vaginitis or herpes in persons

of childbearing potential.

• The following conditions need to be ruled out:Other ulcerative STIs: Primary syphilis (typically painless chancre), chancroid (painful ulcer, rare in many regions), lymphogranuloma venereum (LGV), or granuloma inguinale, depending on epidemiology.

• Noninfectious causes of vulvar ulcers: Aphthous ulcers, Behçet syndrome, fixed drug eruption, psoriasis, trauma, and contact dermatitis should be considered if infectious tests are negative or features are atypical.

• Coinfections: BV increases susceptibility to multiple STIs, so concurrent infections (trichomonas, gonorrhea, chlamydia) should be assessed when BV or Trichomonas is suspected.

Treatment plan

• Immediate measures:

  • Abstain from intercourse until results return and treatment is completed.

  • Avoid douching or fragranced cleansers as they worsen or predispose to BV recurrence.

• If classic painful first-episode ulcers present while awaiting HSV confirmation, I would suggest:

  • Acyclovir 400 milligrams orally three times daily for 7 to 10 days, or

  • Valacyclovir 1 gram orally twice daily for 7 to 10 days.

  • Extend if not healed by day 10.

• If BV is confirmed or highly suspected:

  • Metronidazole 500 mg orally twice daily for 7 days, or

  • Metronidazole gel 0.75 percent intravaginally once daily for 5 days, or

  • Clindamycin cream, two percent intravaginally at bedtime for seven days.

  • Advise consistent condom use during therapy and avoid douching.

• If Trichomoniasis is confirmed or highly suspected:

  • Metronidazole 500 mg orally twice daily for seven days (preferred in women).

  • Treat recent sexual partners and abstain from sex until all parties complete therapy and symptoms resolve.

• If Vulvovaginal Candidiasis is confirmed or strongly suspected:

  • Fluconazole 150 mg orally, with a second 150 mg dose at 72 hours for severe disease, or

  • 7 to 14 days of topical azole.

  • Consider culture/susceptibility if persistent or recurrent.

• For symptom relief:

  • Cool or saline sitz baths.

  • Loose cotton underwear.

  • Gentle hygiene.

  • Analgesics as needed.

• Immediate urgent in-person care is necessary if:

  • Inability to void due to pain/swelling.

  • Severe systemic symptoms.

  • Rapidly worsening ulcers.

  • Concern for disseminated HSV (requires IV Acyclovir).

To prevent this condition further:

• Condom use: Consistently and correctly reduces (but does not eliminate) HSV-2 transmission. Avoid sexual activity during outbreaks or prodromes.

• BV prevention: Avoid douching; consider condom use; seek evaluation for recurrent symptoms rather than repeated over the counter products.

• Trichomoniasis: Ensure partner treatment and abstinence until both are treated; reinfection is common without partner management.

• General STI health: After any ulcerative STI or BV diagnosis, test for HIV and other STIs now and retest as advised by local guidelines.

Reassess within 48 to 72 hours if pain is severe or urination is difficult, or sooner if worsening; otherwise, follow up with results to tailor therapy and counsel on partner management.

I hope this helps.

Thank you.