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Sexually Transmitted Diseases/I'm not sure if this is an STD but I don't know what it is, help?


vulva papillae
vulva papillae  

dry skin/sore area
dry skin/sore area  
Hi, I'm Ruby, age 18. It's quite a long story but I was wondering if you could help.
I live in Amsterdam and before coming home to England for Christmas I had unprotected sex with a guy that showed no visible signs of an infection (and up to this day, he hasn't shown any visible signs) Everything was fine, the week later however when riding my bike back home late one night, my genital area became very very itchy, as in almost unbearable. As well as that, there was a slightly sore area further towards to my anal area. When I finally got home, I did something stupid which was put bioOil on it thinking it would soothe the pain and itching but instead it burned until I washed it off completely and even then it still tinged. I decided to shave my stubble like growing pubic hair as that always makes me very very uncomfortable and I felt a little better. The next day and days afterwards, everything was normal-ish. I was still sore around the anus area and a little itchy from time to time. 2 weeks after the sex however when I came home, things got worse. The itchiness got unbearable again so I self examined myself with a mirror and a flashlight. I found these tiny little spots (see attachment) lining the edge of my labia minora. On oe side of the labia minora, when i touched it, it would hurt, very sore. And also was itchy when I was going about my normal day. I experienced symptoms of painful urination and itchiness from the urethral to the vaginal opening. Of course I started to freak out, thinking maybe its herpes but it didn't look like the herpes or warts pictures online I told myself. As for the soreness, I felt around the area where I felt sore but couldn't see any sores or cuts or anything that could have caused it, though it felt like an open sore feeling. I immediately went to a clinic which I thought could be able to do tests but for some reason they said no. I opted for a screening anyway just to cross chlamydia and gonorrhoea off the lists. Inserting the cotton swab into my vagina hurt excruciatingly for some unbeknownst reason. I got the results back, it showed negative. I did more research online and learned of metronidazole, the antibiotic used to treat most female genitalia infection. When I started my period, I found metronidazole in the medicine cabinet whilst looking for painkillers. I read the instructions and took one dosage of 2g. It took a few days but symptoms started to clear and the bumps started to deflate. The itching however got really bad and I realised it was because of my pubic hair growing again so I shaved and again it got better, however I itched alot of the sore area on my butt still. The next day it was really sore and when I inspected again I found that it had turned into an eczema like outbreak from the lower part of my vagina to my buttocks (see 2nd attacthment). The skin was really dry, in some parts flaky and others closer to my vagina, very sensitive and bled a tiny bit.  That day I stayed in bed and did very minimal moving and the next day it felt better but it was still there. 3 weeks after the sex, I did more research and found the small bumps were identical to a case on this website which I found by googling "vulvar papillae", which in general matched the raised bumps better than anything else I had researched. I've not managed to see a GUM clinic due to new years, boxing day etc- this whole period being one where services are limited. but today I just rechecked myself and the raised bumps have come back. However I also checked and it didn't hurt to put a cotton swab into my vagina. Now I have no idea what it is, why the bumps left and then came back. I also have no idea what's going on with the eczema-like case either. Though painful urination left by taking the metronizadole, the itchiness from the urethral to vagina opening left also but came back recently. I've noticed lastly that when inspecting myself, my vagina would get even drier, I suppose this is because I'm over exposing it.

But yes, after all this I am very confused about my case. I don't know when I'll be able to see a doctor and I would rather not go back to Amsterdam still being in the blue about it.

Any help is appreciated, thank you so much in advance.

Hello Ruby,
Your symptoms suggest several possible conditions, including vulvovaginal candida (yeast), with or without a traumatic injury from sex, and/or herpes or other acute or chronic skin conditions.  It is necessary for you to be evaluated with both a history and physical exam and relevant laboratory tests to determine what you may have and to provide you with appropriate medical management.  The vaginal/vulvar papillae are normal variations in the skin, are of no cause for worry. They do not appear to be HPV/warts. The photos cannot see inside your vagina where there may be ulcerations consistent with herpes. You may not have herpes at all, but the images cannot detect that which is not visible, therefore it can't be ruled out.  Herpes can be exquisitely tender however, as can other problems.

Sorry if this sounds confusing, but sometimes, only a person-to-person visit can piece together the signs and symptoms.

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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