[30F] With severe vaginal itching, pain, and fever

Patient Description

A 30-year-old female presents with severe itching and burning in the genital area, which started three days ago. The patient noticed pimple-like lesions around the anus and red welts around the clitoris. The itching, rated 9 out of 10 in severity, began last night and is somewhat relieved by cold water and ice packs. The patient also reports a white discharge with an odor similar to that experienced during ovulation, and experiences significant burning and stinging during urination. Additionally, the patient has a fever and feels that her whole body is hot, but denies any body aches. No blisters or sores are present. The patient's medical history includes a diagnosis of syphilis in 2012, which was treated with three shots. The condition was under control during the last test conducted last year. The patient is not currently taking any medications.

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Arora's Assessment

What might be happening

Based on the symptoms you've described, here are some possible explanations:

  1. Genital Herpes:

    • Rationale: The presence of blisters, severe itching, burning during urination, and red welts around the clitoris are consistent with genital herpes. This is a common sexually transmitted infection (STI) caused by the herpes simplex virus (HSV).
    • Typical Treatments: Antiviral medications such as acyclovir, valacyclovir, or famciclovir can help manage outbreaks and reduce symptoms. Your doctor may also recommend pain relief measures and topical treatments.
  2. Yeast Infection (Candidiasis):

    • Rationale: The white discharge and severe itching could indicate a yeast infection. While yeast infections typically do not cause blisters, the irritation and redness could be exacerbated by scratching or secondary infections.
    • Typical Treatments: Antifungal medications, either over-the-counter (like clotrimazole or miconazole) or prescription (like fluconazole), can treat yeast infections. Your doctor may also recommend topical creams to reduce itching and irritation.
  3. Contact Dermatitis:

    • Rationale: Although you haven't used new products, contact dermatitis can sometimes occur due to irritation from existing products or materials. The red welts and severe itching are consistent with this condition.
    • Typical Treatments: Avoiding the irritant, using topical corticosteroids, and taking antihistamines can help manage symptoms.

What you can do

For Genital Herpes:

  • Seek Medical Attention: Given the severity of your symptoms and the presence of blisters, it's important to see a healthcare provider as soon as possible. They can confirm the diagnosis and prescribe antiviral medications.
  • Pain Relief: Continue using cold compresses or ice packs to reduce pain and swelling. Over-the-counter pain relievers like ibuprofen can also help.
  • Hygiene: Keep the affected area clean and dry. Avoid tight clothing and opt for loose, breathable fabrics.

For Yeast Infection:

  • Antifungal Treatment: You can try over-the-counter antifungal treatments, but it's best to consult a healthcare provider for a proper diagnosis and prescription if needed.
  • Hygiene: Maintain good genital hygiene, avoid douching, and wear cotton underwear to keep the area dry.

For Contact Dermatitis:

  • Avoid Irritants: Identify and avoid any potential irritants. This includes soaps, detergents, and fabrics that may be causing the reaction.
  • Topical Treatments: Over-the-counter hydrocortisone cream can help reduce inflammation and itching. Antihistamines can also provide relief.

General Advice:

  • Stay Hydrated: Drink plenty of water to help your body manage the fever and flush out any potential infections.
  • Monitor Symptoms: Keep track of your symptoms using the MDandMe journal. This can help you and your healthcare provider identify patterns and triggers.

What you should look out for

Given the severity of your symptoms, you should seek medical care as soon as possible. Reasons to seek care even more urgently include:

  • Increased Pain or Swelling: If the pain or swelling worsens significantly.
  • Spreading Rash or Blisters: If the rash or blisters spread to other areas of your body.
  • High Fever: If your fever continues to rise or you experience chills.
  • Difficulty Urinating: If you have trouble urinating or notice blood in your urine.

Remember, while I can provide guidance based on your symptoms, it's crucial to consult a healthcare professional for a formal diagnosis and appropriate treatment. If you have more questions or need further assistance, feel free to continue the conversation.

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4 mo ago


People Also Ask


What are the common symptoms of genital herpes?

Common symptoms of genital herpes include blisters or sores on the genitals, severe itching, burning during urination, and sometimes flu-like symptoms such as fever and body aches.


How can I differentiate between a yeast infection and genital herpes?

Genital herpes often presents with blisters or sores, severe itching, and burning during urination, while a yeast infection typically causes thick white discharge, itching, and redness without blisters. A healthcare provider can perform tests to confirm the diagnosis.


What are the typical treatments for contact dermatitis in the genital area?

Typical treatments for contact dermatitis in the genital area include avoiding the irritant, using topical corticosteroids to reduce inflammation, and taking antihistamines to relieve itching.


When should I seek medical attention for severe itching and burning in the genital area?

You should seek medical attention if the itching and burning are severe, if you notice blisters or sores, if the symptoms worsen, or if you experience a high fever or difficulty urinating.

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