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Dr. Tim, MD
Dr. Tim, MD, Board Cert. OB/GYN
Category: OB GYN
Satisfied Customers: 1627
Experience:  General OB/GYN, complicated obstetrics, complicated GYN
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I need your help. I have an undiagnosed gynecological

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Hello there! I need your help.I have an undiagnosed gynecological condition since August, when I took antibiotics for an infection with ureaplasma urealyticum. I was prescribed doxycycline twice a day for seven days and Cervugid ovules once a day for twelve days.During and after the treatment I started to develop an inflammation and itchiness, both inside of my vaginal canal as well as on my vulva. On the outer labia there is visible inflammation as well as redness. The discharge is thick and abundant, and sometimes accompanied by a feeling of pressure or fullness in the pelvic area.Those symptoms that are visible have been confirmed by my GP as well. For obvious reasons, I don’t feel comfortable sending photos of my condition over the internet. but she described it as “extremely red and angry”.I was tested again for ureaplasma urealyticum, and also for mycoplasma hominis, thrush, bacterial vaginosis, trichomonas, gonorrhoea, chlamydia, herpes and HPV.Everything came back negative, except the HPV. I tested positive for HPV6 and also for ASC-US.Despite no thrush was detected, I was prescribed Clotrimazole twice a day for two weeks, as well as a pill of Fluconazole every third day for a week.I’m now five days into that treatment and I feel worse than before, so I’m considering discontinuing it. Would you advise that I do so?I am worried because this has been a chronic problem for two months and I don’t want it to get worse, but I also don’t know how many more antibiotics my body can take.Could you please advise my next move?Thank you!

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 age
2.  In August, you were given antibiotics for a Ureaplasma infection
3.  During and after this treatment, you developed vaginal / vulvar inflammation and itching
4.  Your Primary Provider did an exam and described the area as red and angry
5.  You have very thorough testing for everything and it was all negative
6.  You were then given clotrimazole twice a day for two weeks + fluconazole every 3 days for a week
Is that about correct?
Dr. Tim

Here is my answer - please give me a few minutes to type...

Customer: replied 8 months ago.
this is correct, except I do know about an existing infection with HPV 6 and also ASC-US, if that’s somehow relevant.
Customer: replied 8 months ago.
Do you think there must be another infection still ongoing?

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 clotrimazole
2.  I would ask your doctor for a prescription for fluconazole 100mg that you will take EVERY day until the symptoms are gone + one week more
3.  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 area
4.  You will start a probiotic.  In the US, the best one is called Florajen
5.  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?

Customer: replied 8 months ago.
Are you sure this is an yeast infection? I tested negative for it, I’m very sure about that

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).

Customer: replied 8 months ago.
I understand. Surely I should stop taking the cream? It’s supposedly antifugal as well

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.

Customer: replied 8 months ago.
Also, how bad can this get? I never had yeast infections before but I am worried this will haunt me for a while
Customer: replied 8 months ago.
I have a friend who has been getting yeast infections and UTIs multiple times a year since the one time she was on antibiotics many years ago.

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.

Customer: replied 8 months ago.
I understand
Customer: replied 8 months ago.
There’s one more thing
Customer: replied 8 months ago.
What sent me to the gynaecologist in the first place, when my Ureaplasma was diagnosed, was a very strange kind of inflammation, nothing like the one that I have now
Customer: replied 8 months ago.
My doctor had no idea what it was, but i had a round inflammation about the size of a golf ball circa 6-7 centimetres inside the vaginal canal
Customer: replied 8 months ago.
That hasn’t returned since July but I’m concerned that they’re related

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

Customer: replied 8 months ago.
I also have one more question, about the HPV
Customer: replied 8 months ago.
Is there any chance that I can still flush it out of my body after two years, and with all the other problems that are going on?
Customer: replied 8 months ago.
I probably should be getting my hopes too high, right?
Customer: replied 8 months ago.
Shouldn’t *

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

Customer: replied 8 months ago.
Does sexual activity normally change your flora? Does it change permanently?
Customer: replied 8 months ago.
That’s the last question, I promise

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

Dr. Tim, MD and 2 other OB GYN Specialists are ready to help you
Customer: replied 8 months ago.
Thanks for the help Dr. Tim, have a good day!

You are very welcome!!