Sexually Transmitted Diseases/Bumps on vulva


Irritated Vulva
Irritated Vulva  
I'm 23 years old and live in New York City.

I got chlamydia about 5 months ago and was given antibiotics for it. After, I had itching and irritation. My gynecologist gave me antibiotics for bacterial vaginosis and yeast infections. The itching definitely lessened, but didn't completely go away. About 2 months ago, I went back to the gynecologist because I noticed 2-3 small bumps right outside of my vagina. She said it didn't look like anything and may be part of my normal anatomy. She took a swab and found that I had bacterial vaginosis. She gave me antibiotics for it, but I'm not sure that it worked, as I still have minor occasional itchiness. I went back again a week ago to another gynecologist and specifically asked about genital warts, worried about the bumps right outside my vagina. She did an exam and said it wasn't genital warts. What I've had since first noticing the bumps 2 months ago is redness along with some bumps on my vulva (pictured) I'm now worried about these, even though I've been to two doctors and both said I don't have genital warts or herpes. I didn't specifically point these out, but I assume they saw them in my exam. They're not painful, but as I said, I have minor, occasional itchiness and it looks inflamed. Are these just fordyce spots that look worse because my vulva is red? Two doctors examined me and didn't say anything about them, though I can't be sure they noticed them specifically.. Other information: I took an HIV test 2 weeks ago (6 months after my last partner) and was negative. Last PAP was 3 months ago, came back normal, but had a sexual partner 1 month beforehand.
Please help!

Hello Rachel,
Chlamydia, as you know, is one of the most common STDs, and is easily treated with antibiotics, sometimes causing an unpleasant yeast vaginal infection as a consequence. This can cause itching.  Bacterial vaginosis is NOT a consequence of the antibiotic therapy, but may be a co-existing condition that is only made more evident after the primary chlamydia infection is treated. Metronidazole gel is usually more effective than the pill form of the same medication, however the condition we call "bacterial vaginosis" is really a condition of certain germ overgrowth and imbalances that can be more or less sensitive to certain treatments. In other words, treatments are not always effective.

Your shaving the pubic hair can cause irritation. The tiny bumps you see are enlarged sebaceous glands that are a normal condition of the non-hairy areas of the vulva. The photograph does NOT appear to have herpes or warts, and the symptoms you describe are not suggestive of these STDs.

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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