OB-GYN (Obstetrician-Gynecologist) | Gynecology Questions OB-GYN

How do I know if I have a yeast infection or herpes?

I am having trouble discerning whether I have a yeast infection or genital herpes. My Dr's office is closed today and it is going to be the weekend, as well as with COVID I don't really want to go into an office if I can avoid it. I started seeing my boyfriend and becoming sexually active in October, it had been years since I had been active prior. My bf and I are long-distance and I recently started taking birth control (the minipill) in October as well. I just got back from seeing my bf over a two week period. During this period I wasn't having any problems until about the last day or two before I left.

On Saturday, I was starting to feel some soreness after sex which had happened before and was minute so I didn't think much of it. The next day we had sex again and there was much more pain during sex, I think in turn from the original irritation as well as some vaginal dryness. After my vagina was pretty sore again, I don't remember any itching during this time. Two days later I get home, am still experiencing soreness, and started to notice I was feeling a little inflamed. I take a look using my mirror and notice some bumps/cysts on the labia. I wasn't in too much pain or discomfort at this point so I chalked it up to just normal irritation or possibly ingrown hairs for I had tried Brazillian waxing myself for the first time 2 weeks prior.

The next day some of the cysts have opened with a couple on the inside of the lips which has made urination quite painful. The labia is still swollen and irritated. I don't have any cottage cheese-like discharge, it has been kind of normal, white or pale yellow, there is one small white area on the inside of one of my labia, as well as a little dried yellowish secretion at the edges of the top of my labia. I haven't noticed any unusual smell. When I was with my bf I did run out of my birth control so there were a few days I wasn't taking it, this was when the pain during sex was happening. We also used a condom the entire time both of these times which we don't normally do. My bf hasn't been tested and never had any symptoms of herpes. I did get some Monistat 7 but was afraid to use it yet in case it might make herpes worse if that is what I have.

Female | 24 years old
Complaint duration: 4 days
Medications: Birth Control

4 Answers

Herpes is small ulcers and painful yeast causing itching and burning. Get tested.
Your symptoms and description are more consistent with herpes, but it can be type I (after oral sex) or type II. You can go to urgent care or city md to have someone take a look and do a culture.
The yeast infection is mostly in a large area. The genital herpes give pain and itching in a very specific area (as a burning) sensation.
Your assessment is quite good and historical; thank you for that. First, I don’t think this is HSV (herpes simplex virus) as there is usually a prodrome of tissue tingling before any lesions appear and they are quite painful, not just when urinating but HSV can masquerade with other viruses so you are right to be wary. Second, I think the yellow-tinge to the vaginal discharge means more and could actually be a Chlamydia or other bacterial overgrowth (did you use a condom EVERY time or were there a few ‘misses’?); likely not Bacterial vaginosis as that would have a rotten fish odor. Chlamydia can affect your future fertility and it can have anything from symptoms that you describe to absolutely no symptoms; so getting a culture is important as you don’t want internal scar tissue closing off your Fallopian tubes causing infertility down the road; simple antibiotics cure Chlamydia. Third, yeast does not always have a white chunky discharge; it can be early with no discharge or it can be white creamy as it starts to progress; only when it’s been there a little while or it’s a really strong yeast infection do you visibly see the white chunks. One of the easiest things to do over the weekend is use a topical cream such as Monistat or even A&D or Desitin (yes, the baby’s diaper rash creams because butt skin yeast is what A&D and Desitin were formulated for. And if it’s kind enough for a baby’s bottom, it will be kind enough for your bottom.) Fourth, when you start on OCP’s (oral contraceptive pills) or birth control, your normal hormone levels get suppressed and the artificial hormones of the pill take over. In many cases your vaginal tissues take longer to respond to their ‘loss of elasticity’ from going on OCP’s or Mirena or other hormone containing contraception and you will notice any ‘stretch’ of the vaginal tissues will become uncomfortable and stinging due to decreased elasticity (the same thing happens with perimenopause and menopause), something most healthcare providers just conveniently forget to tell patients. Add that to a sudden and daily increase in relations and it’s the perfect storm of vulvar and vaginal irritation that is hormone-deprivation based, and likely not even infection based. Think of the comparison of any other mucosal tissues getting a sudden increase in activity and decrease in natural ‘tissue protection’ like natural hormone; it’s not uncommon, therefore, to have the symptoms that you describe.