Yeast or something else?

[llle]

Dr. H - I am at my wits end and need guidance as to what to do next.I have posted in the past (May) and continue to have the same problems with burning/irritation around my labia that comes and goes every couple weeks, some discomfort during sex(only when irritated and only at vaginal opening, not vagina), no burning with urination, no bleeding, no discharge.I took your advice and went to see a friend of mine who is a NP (and also works at Planned Parenthood) To be sure,did Chlam and Gon tests,both neg and Herpeselect-neg. She said it looked red around labia/vag.opening but vagina looked fine.Said there was quite a bit of thick white vag. secretions without odor so did a wet mount and said there were absolutely no abnormal cells(not even yeast or clue(sp)cells). About 1month later, had my PAP with my GYN, pap norm. He also said everything looked "fine". Discussed poss.of hormonal issues (labs normal), was on Premarin without any relief. Cont to have this irritation/redness/discomfort. Also have had mult. yeast infections in the past few months that respond to diflucan only, above symptoms dissappear for a few weeks, then back again.  No overt discharge, just symptoms described above. Last week I developed an eye infection (chronic (5 years)spontaneous corneal ulcers) and was placed on Doxycyline 100mgqd for 6weeks to get rid of blepheritis. Within 2 days (this morning), had raging yeast infection with cottage-cheese like yellowish-white discharge and more redness.  I am extremely frustrated with these continued symptoms without any explanations.  
1.  Could this be a persisent yeast infection that is not going away?  If so, why?
2.  Any possibility of a vaginitis/vaginosis even after a wet mount and NO foul thin discharge?
3.  What about Vulvodynia or vestibulitis? I have cut out all allergans as best as I can.
4.  What should be my next step?  Return to my GYN?  See my NP?
See someone else? Or try other treatment?
Any possibilities/suggestions would be greatly appreciated.  I am willing to try anything to get rid of this and return to normal.  I respect your opinion and advice and would appreciate any help you can give.
Thanks again for this forum.

[H. Hunter Handsfield, M.D.]

Trich is only acquired sexually.  The origins of BV often are mysterious; not all cases are sexually acquired.  But BV is always painless, without itching etc; it clearly is not your main problem.

Ask your gyn for referral to a provider who is particularly expert in both gyn and infectious disease.  Or seek one out yourself.  There are such specialists affiliated with many major medical centers, especially those associated with medical schools.

This will have to be my last response.  Good luck--   HHH, MD

[llle]

Thanks for your helpful comments.  

1. I don't believe the blepheritis,etc are causing my chronic problems.  I only mentioned it because I think the Doxy is the cause of this current yeast that started this morning.  I brought up the blepheritis only to explain the reason for the Doxy...don't think it is the cause of the chronic issues.  

2. Like in my previous thread, I have only been with my husband in 12 years (except the incidence in March which you didn't even feel was an exposure whatsoever)and I know for certain my husband has never been with anyone else is these 12 yrs. So, I had not been checked for BV/Trich since my pregnancies. When I had my Pap/Exam 1 month ago (Sept), a scraping and wet mount was done. I assumed that is how they check for BV/Trich.  If they found nothing abnormal on wet mount and visually, is that enough? If not, what other tests can be done to check?

3. Are either BV/Trich obtained other ways than sexually transmitted? If so, what are they?

4. Since my GYN didn't bring up the vulvodynia, I will talk with him about it.  But if cont. to be at a loss, where do I go for a second opinion?  Another GYN or maybe a Derm?  Don't know the best route or provider to start with to find relief or at least help.

I probably should have posted on Derm but regardless, thanks for your patience and for answering these questions as well since I know you are not obligated to do so.  I respect your opinion and need help knowing where to start with this very frustating issue.  

Again, this website is so very valuable.  Thanks.

[H. Hunter Handsfield, M.D.]

My expertise doesn't really include non-STD vulvovaginal infections, aside from the 3 common ones typically managed in STD clinics (yeast, BV, trich). The discharge you describe doesn't sound like any of those--but of course if you haven't been evaluated recently for BV and trich, that should be done.

HHH, MD

[llle]

Sorry - I had a couple more questions and forgot to add to previous comment.
I have had, in the last 6 months, slight green-brown discharge, but only during a yeast infection and it is gone after treatment of yeast infection.  
Is this normal for a yeast infection or could this be due to vaginosis (trich)? If yes, would the vaginosis symptoms come and go and clear up for a couple of weeks after yeast treatment?
And can't I assume it is not this because wouldn't it show up on the wet mount or upon visiual inspection during my pap?  Just curious because I am at a loss.  Thanks

[H. Hunter Handsfield, M.D.]

I wish I could help, but I doubt that I can.  The most likely explanation for your symptoms is idiopathic vulvodynia.  That fancy name really doesn't say anything; literally it means vulvar pain of unknown cause.  You already know that much!  Whether it has anything to do with your blepharitis, medications, or anything else, I cannot say.  Vulvodynia is fairly common and very frustrating to both persons who have it and their helath care providers.  Since your gynecologist didn't even suggest that possibility, it seems likely he doesn't know much about it.  You should ask for referral for a second opinion.

1,2) I doubt you have yeast or any other form of standard, recognized vaginal infection.  3) As I said, vulvodynia seems possible.  4) Either return to your current providers or get the opinion of another one, preferably someone with experience with this problem.

But I cannot get more specific.  I do not treat vulvodynia myself and have no personal experience with patients with the syndrome.  It isn't an STD, so when we suspect it in the STD clinic, we refer to gynecologists.

Sorry I can't be more helpful.  Best wishes--  HHH, MD