Sexually Transmitted Diseases/What is this?


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QUESTION: I am Abby, a 26 year old female from USA. In the past week I have had these spots on the opening of my vagina. I was recently diagnosed with herpes type 1 on the genitals back in August. I have been with the same partner since July and tested negative for hpv & all other stds in August during my yearly Pap smear & everything came back normal except for HSV. My first outbreak was awful, but I haven't had anymore issues with it since so I'm not sure what to look for to know when I'm about to have another one. Last week, my boyfriend and I had rough sex for several hours. Could it be something to do with rough sex, herpes, or another STD?

ANSWER: Hello Abby,
It appears that your episode of "rough sex" may have caused some swelling and redness, with an overgrowth of yeast. Yeast is an opportunistic fungus that causes superficial infection of the skin from trauma associated with friction from sex.  An effective antifungal cream (terconazole, miconazole) and/or tablet by mouth (fluconazole) should be effective. These are all prescriptive medications.

Good luck!

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Inside vagina
Inside vagina  

Bumps and a sore place
Bumps and a sore place  
QUESTION: Hi again! So I went to the doctor and they gave me fluconazole. I took that medicine and things still haven't gotten better. I have another appointment Monday, but I am freaking out a little bit. I posted pics to show what it looks like now.

Hello Again, Abby,
Hopefully your doctor examined a sample of your vaginal discharge under a microscope to make the diagnosis!  The cut or scratch you have could be just that, or it could be due to a herpes virus, which sometimes cause this type of appearance rather than a typical round ulcer or blister.   The elevated bumps may be normal, or they may be warts.  A proper exam requires the wiping away of the white discharge, and examining the bumps with a bright light and from different angles to see whether it is a normal variation, or a wart caused by HPV.  

Good luck!

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Mark P. Behar


Almost any question or concern about gay men's health issues, sexually transmitted infections, abnormal Pap smears, anal cytology (anal "Pap smears"), etc. There is no such thing as “d/d free” or “clean” (free of infection), so why do so many of us deceive ourselves into thinking that some people are indeed totally free from a potentially infectious disease, like HIV, herpes, hepatitis, syphilis, chlamydia, warts, gonorrhea, etc., just because they say so? Clinical laboratory tests are not perfect, and having a “negative” or “nonreactive” test does not mean that a person is free from infection. Perhaps at the moment the test was taken, the person was uninfected; or, perhaps, the test wasn’t sensitive enough to detect presence of the infection. There is really no way that anyone can determine that they are truly “disease free,” and there are over a hundred of infectious conditions that can be spread without your knowing anything. Rather than trying to “pre-screen” or “serosort” a potential sex-mate with deceptive questions that are impossible to know by today’s technologies, a wiser option may be to consider everyone infected with something, and either use appropriate protective measures (“safer sex”), or accept the responsibility and consequences of possibly “catching” something from someone who’s hotter than expected (pun intended!). There is much research that supports the contention that an HIV positive person reliably taking HIV medications, and having an undetectable viral load, presents a lower risk for transmission of HIV than people who may think or say they are HIV negative, but are not. Food for thought!


Family Practice PA since 1981; Volunteer Clinician for Brady East STD (BESTD) Clinic, Milwaukee, since 1977; answered STD questions submitted to their web site. Professionally lectured at national and regional Physician Assistant and Nurse Practitioner conferences, and at national gay & lesbian health conferences on topics including HIV/AIDS, herpes, hepatitis, STDs, human papilloma virus (the cause of venereal warts), abnormal Pap smears, gay and lesbian health issues, among others.

Co-Founder, Lesbian, Bisexual, & Gay Physician Assistant Caucus of the American Academy of Physician Assistants, Inc.; American Academy of Physician Assistants; Wisconsin Academy of Physician Assistants; National Co-Chair (2012-16), National Association of Black and White Men Together: A Gay, Multiracial Organization for All People (NABWMT)

Journal of the American Academy of Physician Assistants (JAPA) Q Visions, Quarterly Newsletter of the NABWMT

Bachelor's of Arts, 1972 (University of Wisconsin, Milwaukee, WI) Graduate Credits Experimental Psychology, 1972-75 (Tulane University, New Orleans, LA) Physician Assistant, Bachelor's of Science, 1981 (George Washington University, Washington, DC); Masters in Physician Assistant Studies, 2000 (University of Nebraska Medical Center, Omaha, NE)

Awards and Honors
Colposcopy Recognition Award (CRA), the American Association of Colposcopy and Cervical Pathology; Distinguished Fellow, Clinical Preceptor, American Academy of Physician Assistants; Fellow, Wisconsin Academy of Physician Assistants

Past/Present Clients
Brady East STD Clinic, Milwaukee, WI Milwaukee Health Services, Inc. (Martin Luther King Heritage Health Center), Dept. of Family Medicine and Early Intervention Program for HIV Infected Persons

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