Pus-filled vaginal sores

Dear Alice,

I have pus-filled sores near my vagina, what could this be? They usually come when I get my period. It gets very itchy. Could it be herpes?

— Worried

Dear Worried,

It’s great that you’re keeping track of changes to your body and seeking clarity on potential causes. While herpes is certainly a possibility, the symptoms you’re experiencing may be related to a number of conditions such as syphilis or a bacterial infection. These conditions can all cause sores, so to get a more definitive answer and treatment plan, it’s wise to seek a diagnosis from a health care provider.

Given your symptoms, it’s understandable that you’re concerned about herpes. Herpes is a sexually transmitted infection (STI) that causes genital sores when someone is infected with herpes simplex type 1 (HSV-1) or herpes simplex type 2 (HSV-2). A herpes episode usually begins with a tingling or itching sensation of the skin in the genital area. Then, sores appear, starting as one or more red bumps. These change to watery blisters within a day or two as the sores rupture, leaving shallow ulcers that may ooze, weep, or bleed. After around three or four days, a scab forms and the sores often heal themselves without treatment. Other herpes symptoms include painful urination, dull ache or a sharp pain in the genital area, frequent urge to urinate, vaginal discharge, or vulvitis (a painful inflammation of the vulva). It’s worth noting that many people with HSV-2 have recurrent herpes episodes. You mention that you’ve noticed these sores appear around your period; while menstruation can cause recurrent episodes of herpes, it can also be triggered by factors such as stress and illness.

Though genital sores are common with herpes, it’s also a symptom of another STI, syphilis. During the primary stage of syphilis infection, a few sores, known as chancres, typically appear and heal on their own after three to six weeks. However, if the infection isn’t adequately treated, it can progress to the secondary stage of infection, which is often characterized by rough, reddish-brownish, rashes that are typically-spot shaped and can appear throughout the body. These rashes may sometimes be accompanied by large, raised, gray or white lesions that appear in the moist areas of the body such as the groin. Additionally, some people experience fever, swollen lymph glands, sore throat, patchy hair loss, headaches, weight loss, muscle aches, and fatigue. Without treatment at this stage, the symptoms will likely disappear on their own, but the syphilis infection will go into the latent stage. This is characterized by the absence of symptoms; in rare cases, the infection will then further progress into a tertiary stage. The infection may progress into this tertiary stage anywhere from 10 to 30 years after initial infection, but can severely affect the body by causing neurodegenerative effects, organ failure, and even death.

STIs aren’t the only potential cause of your sores. They may also be caused by a bacterial infection. Sometimes a hair follicle is infected and forms boils, which are painful, swollen bumps filled with pus. They’re similar to pimples but are bigger and more deeply inflamed. If a cluster of boils forms (known as a carbuncle), this may lead to a fever. The treatment would involve your health care provider cutting open the boil to remove the infection. It’s best that you don’t try this on your own for risk of spreading the infection to other parts of your body if done improperly. Complications, such as the formation of a carbuncle, may require additional treatment such as prescription antibiotics.

Due to the number of conditions that cause sores, you might want to consult with your health care provider for more a definitive answer. In the meantime, if you'd like relief from the discomfort, you could consider remedies such as a sitz bath. Sitz bath kits can be purchased online or in the pharmacy section of a store and come with detailed instructions. Whatever you decide, you’ve done a great job tracking your symptoms. Keeping note of the timing and characteristics of your sores can better inform a treatment plan if you do decide to meet with a medical provider. 

Wishing you relief, 

Last updated Feb 26, 2021
Originally published Oct 01, 1993

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