Ask a Gynaecologist and Get Answers to Your OB/GYN Questions ASAP
Hello and I would be happy to try to help you with what sounds like a complicated situation. Just to get the facts straight, here is what I know:1. You are 26 years of age2. In August, you were given antibiotics for a Ureaplasma infection3. During and after this treatment, you developed vaginal / vulvar inflammation and itching4. Your Primary Provider did an exam and described the area as red and angry5. You have very thorough testing for everything and it was all negative6. You were then given clotrimazole twice a day for two weeks + fluconazole every 3 days for a weekIs that about correct?Dr. Tim
Here is my answer - please give me a few minutes to type...
First, I am terribly sorry that this is happening to you. This is one of those situations where the treatment created new and worse problems. You were treated for Ureaplasma with an antibiotic that basically tilted the scales in favor of a terrible yeast infection of the vagina and vulvar area. This is a very common story and sometimes it may seem hard to get back to normal. Based on what you are telling me, here is what I would tell a patient:1. I would stop the clotrimazole2. I would ask your doctor for a prescription for fluconazole 100mg that you will take EVERY day until the symptoms are gone + one week more3. I would ask your doctor for a prescription for a steroid ointment that you can apply to the external vulvar region. The one that we would use in the US is called clobetasol 0.05% ointment. You will apply this twice daily to the outside vulvar area4. You will start a probiotic. In the US, the best one is called Florajen5. The pap smear showing ASCUS (atypical squamous cells) is completely unrelated. The pap smear is abnormal, likely, because of all the other inflammation. HPV6 is a common strain of HPV virus that is associated with warts. If you have no warts then do not worry about this. A repeat pap smear in about 6 months is what you need.This is the best course of action. This is clearly an out-of-control vulvovaginal yeast infection precipitated by the use of antibiotics and the abnormal pap smear is related to the infection, not a pre-cancerous change of the cervix.Dr. Tim
Does this make sense?
It is funny to me when we sometimes revert to treating a test result instead of what we see right in front of our eyes. You were on antibiotics (which will predispose you to yeast infections) and an exam shows a red and inflamed vulvar / vaginal area which is consistent with a yeast infection. I really would not care what the culture shows. In fact, I probably would not even have done the culture. This is a yeast infection until proven otherwise and should be treated more aggrressively.Dr. Tim
If your doctor is resistant to changing course, then I would immediately seek a second opinion. You are miserable and at the very least, they need to give you something to get the itching and inflammation under control (clobetasol).
Yes, it is an anti-fungal. But I am suggesting that the infection has gone way beyond what a vaginal cream can treat. Also, it is possible that you are reacting to the cream itself. The oral diflucan is a better way to go as it does not involve adding anything to the already inflamed area.
But, every third day is not enough. You have nothing to lose changing to a slightly lower dose and taking it daily.
I cannot comment on your friend, but this cannot get much worse. The goal is to get back to normal and if at any point in the future you need antibiotics, you need to get a prescription for diflucan that you take at the same time.
Regardless of this prior finding (which is now gone), it seems as though the problem that you have now has been created by the use of antibiotics. I still stick by my original plan. Yes, they are related in so far as you were placed on antibiotics which created the problem in the first place.Dr. Tim
By virtue of the fact that you are a human being who has ever been sexually active, you have been exposed to the HPV virus. If you have no warts, YES, you can clear this easily on your own. Your immune system will, in most cases, take care of this with no future problems.Dr. Tim
Being normally sexually active will not change the normal vaginal flora. The use of lubricants might have such an effect, but normal sexual activity, in and of itself, would not cause such a problem nor would it make it harder to clear.Dr. Tim
But my guess is that you cannot have intercourse under the circumstances!!
It has been a pleasure to help you with what I would say is a very complicated question. I think that we outlined a decent plan moving forward. I sincerely ***** ***** this has helped!Dr. Tim
You are very welcome!!