I have a vaginal rash and mouth ulcer. Could they be related?

Dr Flo,
I have been to several doctors because of a mouth ulcer on one lip. I get treatment and the ulcer disappears only to come back after a few months. I also have hyperacidity. In addition to this, I have a vaginal rash and severe itch. I have been to three different gynaecologists and had pap smears, but nothing was found. I was given yeast infection medication, which only helped for a while. I try to eat clean and make sure I eat fruits and vegetables in every meal because I have had health issues since childhood. Could the mouth ulcer and vaginal rash be related? How best can I treat the two once and for all or which doctor should I see?

Dear Jo,
You most likely have an aphthous ulcer on the lip, otherwise known as canker sores. In most cases, there is no known cause for aphthous ulcers. They may appear when you bite yourself when you are stressed if you do not sleep or eat well, if you lose weight too fast if you take acidic foods or drinks or have hyperacidity if your immunity is lower like when you have a cold, or there are hormonal changes, or even from bacterial, fungal or viral infection. It may also be from vitamin B12 or folate deficiency. Some people are genetically predisposed to having the sores, and this may be a result of an auto-immune disease. In an auto-immune illness, the body’s immune system forms antibodies against some tissues in your own body, in this case, against your mucous membranes. You may benefit from screening for vitamin B12 and folate deficiency and for auto-immune illnesses like Behcet’s, crohn’s disease, and lupus.

You cannot completely eradicate the apthous ulcer since by nature, it is recurrent. To manage it, gargle with some salty water or mouth wash, use some topical creams to relieve the pain and inflammation, and use anti-viral medication for cold sores if you have them. Avoid very hot food or drinks, and avoid very salty, spicy, or acidic foods. Take a lot of water, manage the hyperacidity, and have good dental care. Vitamin B and folic acid supplements may also be of help. If a sore lasts for more than two weeks without healing, you need to be reviewed by a doctor.

It is normal for all women after puberty to have a vaginal discharge. It is a mixture of fluid and cells that help to keep the vagina clean and moist and to prevent infection. The appearance changes depending on the menstrual cycle, and can also be affected by exercise, stress, use of hormonal medication, and sexual arousal. The discharge may vary from white to clear, and from watery to thick, at different times of the cycle. It is also normal to have a brown or bloody discharge just before, during, or after your periods, or sometimes in between your periods (spotting).

If there is abnormal colour (yellow, green, sometimes white), itching, a foul smell, or thick, chunky discharge, then most likely there is a vaginal infection. The infection may be caused by fungi, bacteria or other organisms. An infection may also cause pain when passing urine or pain during intercourse. Because of the recurrence, you should have a high vaginal swab (HVS) and culture done to see if there is an infection or the discharge is normal. If it is established to be candidiasis, you can be put on antifungals for several consecutive months to prevent a recurrence. Any other infection will be treated appropriately. A pap smear may not be very helpful in this case since it specifically checks for cancer of the cervix.

For some people, there is no identifiable reason for the recurrence of candidiasis; however, it may occur due to having low immunity, or diabetes, or long-term use of steroid medication. Any infection can be transmitted, though it is not common to transmit candidiasis from a female to a male partner. Candida infection on the penis can be easily treated using a topical cream.

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