Painful Urination II

Sally Pitkin came in complaining of painful urination. When I went into the exam room to see her, she described the pain as very severe, on the outside. While dysuria is among the classical symptoms of urinary tract infection, the pain associated with UTI is more focused in the bladder, often occurs at the end of urination, and is milder in severity. Because she complained of severe, external pain, I suspected herpes.

She said she had had this pain for about a day, but that it had been preceded by a stinging sensation on the vulva. I asked her if she had noticed and blisters or ulcers on her vulva, but she didn’t know.

When I examined her, I found several typical lesions on the vulva of herpetic infection. These were round or oval ulcerations, about 2-3 mm in diameter. Each was filled with a grayish white material and was excquisitely tender to touch.

I told her she had herpes and recommended she start Zovirax as an antiviral treatment. The antivirals will shorten the duration of the attack, and decrease the likelihood of a recurrence.

Naturally, she was extremely upset and wanted to know where she had gotten this from. I advised that she acquired it from someone else who was carrying the virus, either in their genital area or their mouth.

We also discussed primary and recurrent infections, Type I and Type II infections, and the need to avoid intercourse until we had a chance to discuss this further.

I had her go home then, to return in a couple weeks