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Dermatology (Expert Forum)
FOLLO W UP TO HERPES OBSESSION
Answered by
Alan Rockoff, MD - dermatology, Child Skin Problems
The Rockoff Dermatology Center
Brookline - MA
This forum is for questions regarding Dermatology issues, such as: skin rashes, acne, birthmarks, skin infections, rosacea, and general skin care.
FOLLO W UP TO HERPES OBSESSION
by DELLMAN, May 19, 2003 12:00AM
DEAR DOCTOR,
BEFORE YOU SAY I AM STILL OBSESSED WITH THIS HERPES THING...PERHAPS YOU ARE RIGHT,BUT I AM GOING TO A NEW DERMATOLOGIST TOMORROW. I DID FAIL TO MENTION HOWEVER THAT THE PRIOR DERMATOLOGIST TOOK A BACTERIAL CULTURE AS WELL AS A FUNGAL AND VIRAL CULTURE FROM THE SCROTAL SKIN AREA. WHILE THE FUNGAL AND VIRAL CAME BACK NEGATIVE,THE BACTERIAL CULTURE WAS POSITIVE FOR A BACTERIUM CALLED "ENTEROCOCCUS" WHIICH IS APPARENTLY FOUND IN THE GI TRACT. SHE PRESCRIBED 10 DAYS OF PENACILLIN,BUT THIS HAD NO IMPACT ON THE SCROTAL RASH AND SHE FELT THAT THE BACTERIUM WAS PROBABLY A "CONTAMINENT" FROM THE GI TRACT.
I KNOW YOU SAID THAT HERPES PRESENTS AS A BLISTER OR CLUSTER OF BLISTERS,BUT THE CDC SIGHT FOR STDS DOES STATE THAT A MILD OUTBREAK OF HERPES CAN SHOW UP AS A RASH ON THE PENILE SHAFT AND/OR SCROTUM. I DON'T KNOW IF THEY MEAN THAT THE RASH PRECEEDS THE OUTBREAK OF THE BLISTERS OR THE RASH IS THE ONLY MANIFESTATION.
MY CONCERN HERE IS THAT I ORIGINALLY HAD A FEW RAZOR TYPE BURNS ON MY FORESKIN AND BACK OF MY PENIS AND WHILE THEY CLEARED UP IN A WEEK OR SO THE REDNESS ON MY SCROTUM HAS PERSISTED FOR THREE PLUS MONTHS ALONG WITH THE PENILE DISCOMFORT.
MY QUESTIONS ARE AS FOLLOWS
1) COULD ENTEROCOCCUS CAUSE A SKIN RASH AND URINARY TRACT DISCOMFORT AND IS IT POSSIBLE THAT IT COULD BE RESISTANT TO PENACILIN?
2)DOES GENITAL HERPES ALWAYS CAUSE BLISTERS IN SUSEQUENT OUTBREAKS?
3)COULD HERPES SIMPLEX I(ORAL HERPES) CONTRACTED IN THE GENITAL AREA BE A MILDER FORM OF HERPES.
4)ARE THERE ANY STDS YOU KNOW OF THAT COULD PRODUCE A SCROTAL SKIN RASH THAT BURNS AND IS COVERING MOST OF MY SCROTUM AND PERSIST THIS LONG AND ALSO PRODUCE URINARY TRACT DISCOMFORT?
DOC, I KNOW YOU HAVE ADVISED ME PREVIOUSLY ABOUT THE STRESS AND ANXIETY FACTOR OF ALL OF THIS AND IT'S POSSIBLY CAUSING MOST OF MY SYMPTOMS,(THEY DO SEEM TO GET WORSE AS THE DAY PROGRESSES i.e. THE REDNESS AND URINARY DISCOMFORT)...THIS WILL BE MY LAST INQUIRY, BUT AS A RATHER HEALTHY ADULT WHO HASN'T BEEN ILL FOR YEARS...AND THEN ONLY A COLD,I KNOW MY BODY,I HAVE NEVER BEEN A HYPOCHONDRIAC, AND SOMETHING ISN'T RIGHT HERE.
ALL THE DOCTORS CAN TELL ME WHAT IT ISN'T, BUT CANNOT TELL ME WHAT IT IS...VERY FRUSTRATING.
THANKS
BEFORE YOU SAY I AM STILL OBSESSED WITH THIS HERPES THING...PERHAPS YOU ARE RIGHT,BUT I AM GOING TO A NEW DERMATOLOGIST TOMORROW. I DID FAIL TO MENTION HOWEVER THAT THE PRIOR DERMATOLOGIST TOOK A BACTERIAL CULTURE AS WELL AS A FUNGAL AND VIRAL CULTURE FROM THE SCROTAL SKIN AREA. WHILE THE FUNGAL AND VIRAL CAME BACK NEGATIVE,THE BACTERIAL CULTURE WAS POSITIVE FOR A BACTERIUM CALLED "ENTEROCOCCUS" WHIICH IS APPARENTLY FOUND IN THE GI TRACT. SHE PRESCRIBED 10 DAYS OF PENACILLIN,BUT THIS HAD NO IMPACT ON THE SCROTAL RASH AND SHE FELT THAT THE BACTERIUM WAS PROBABLY A "CONTAMINENT" FROM THE GI TRACT.
I KNOW YOU SAID THAT HERPES PRESENTS AS A BLISTER OR CLUSTER OF BLISTERS,BUT THE CDC SIGHT FOR STDS DOES STATE THAT A MILD OUTBREAK OF HERPES CAN SHOW UP AS A RASH ON THE PENILE SHAFT AND/OR SCROTUM. I DON'T KNOW IF THEY MEAN THAT THE RASH PRECEEDS THE OUTBREAK OF THE BLISTERS OR THE RASH IS THE ONLY MANIFESTATION.
MY CONCERN HERE IS THAT I ORIGINALLY HAD A FEW RAZOR TYPE BURNS ON MY FORESKIN AND BACK OF MY PENIS AND WHILE THEY CLEARED UP IN A WEEK OR SO THE REDNESS ON MY SCROTUM HAS PERSISTED FOR THREE PLUS MONTHS ALONG WITH THE PENILE DISCOMFORT.
MY QUESTIONS ARE AS FOLLOWS
1) COULD ENTEROCOCCUS CAUSE A SKIN RASH AND URINARY TRACT DISCOMFORT AND IS IT POSSIBLE THAT IT COULD BE RESISTANT TO PENACILIN?
2)DOES GENITAL HERPES ALWAYS CAUSE BLISTERS IN SUSEQUENT OUTBREAKS?
3)COULD HERPES SIMPLEX I(ORAL HERPES) CONTRACTED IN THE GENITAL AREA BE A MILDER FORM OF HERPES.
4)ARE THERE ANY STDS YOU KNOW OF THAT COULD PRODUCE A SCROTAL SKIN RASH THAT BURNS AND IS COVERING MOST OF MY SCROTUM AND PERSIST THIS LONG AND ALSO PRODUCE URINARY TRACT DISCOMFORT?
DOC, I KNOW YOU HAVE ADVISED ME PREVIOUSLY ABOUT THE STRESS AND ANXIETY FACTOR OF ALL OF THIS AND IT'S POSSIBLY CAUSING MOST OF MY SYMPTOMS,(THEY DO SEEM TO GET WORSE AS THE DAY PROGRESSES i.e. THE REDNESS AND URINARY DISCOMFORT)...THIS WILL BE MY LAST INQUIRY, BUT AS A RATHER HEALTHY ADULT WHO HASN'T BEEN ILL FOR YEARS...AND THEN ONLY A COLD,I KNOW MY BODY,I HAVE NEVER BEEN A HYPOCHONDRIAC, AND SOMETHING ISN'T RIGHT HERE.
ALL THE DOCTORS CAN TELL ME WHAT IT ISN'T, BUT CANNOT TELL ME WHAT IT IS...VERY FRUSTRATING.
THANKS
Doctor's Answer
by Alan Rockoff, MD, May 20, 2003 12:00AM
, May 20, 2003 12:00AM
1. No. Your doctor is surely right to say enterococcus is a contaminant.
2. Yes, outbreaks always start as blisters.
3. Oral herpes (Type 1) may be milder, but still has blisters.
4. No, there aren't. On the other hand eczema of the penis and scrotum, spontaneous or indiced by rubbing, presents exactly this way.
Sometimes circumstances can make a non-hypochondriac into a chronic worrier. As Hamlet said,
Thus conscience does make cowards of us all.
And thus the native hue of resolution
Is sicklied o'er with the pale cast of thought
He was talking about whether to be or not to be, but he might have had you in mind.
Get medical clearance (you basically already have), get the psychological help you need, and move on. The fact that you aren't a chronic worrier makes optimistic that you will.
Take care.
Dr. Rockoff
2. Yes, outbreaks always start as blisters.
3. Oral herpes (Type 1) may be milder, but still has blisters.
4. No, there aren't. On the other hand eczema of the penis and scrotum, spontaneous or indiced by rubbing, presents exactly this way.
Sometimes circumstances can make a non-hypochondriac into a chronic worrier. As Hamlet said,
Thus conscience does make cowards of us all.
And thus the native hue of resolution
Is sicklied o'er with the pale cast of thought
He was talking about whether to be or not to be, but he might have had you in mind.
Get medical clearance (you basically already have), get the psychological help you need, and move on. The fact that you aren't a chronic worrier makes optimistic that you will.
Take care.
Dr. Rockoff
Did you read my last reply. I am going through the same thing right now. My dermatologist just brushed it off. I also have been to a few doctors and cause my blood tests came out negative they were basically telling me it's in my head. I know my body. It has never felt this way. I have had redness going on four months now and pain in my lower back and thighs. My lips and tongue sometimes bother me also. That is why I think I have herpes and not really any sores cause I have type 1, which I read is milder also. I am so tired of living in this discomfort. I don't know where to go next
Nobody's blowing anybody off. They're telling you that you have an irritation other than herpes. If you're unwilling to accept that, you may need to deal with the consequences.
Dr. Rockoff
you may find the following thread useful (Dr.Rock as well).
http://dermatology.cdlib.org/rxderm-archives/scrotopyrosis
It is an exchange between several doctors mainly describing perplexity but also some possible solutions/reasons for the symptoms
It gave me some comfort in that the condition is widespread and not always "just in your head" - there are other potential causes.
The thread is interesting as it may offer some ideas as to alternative possibilities (The psychological aspect is strong, but as I am a confident, very healthy, strong minded individual who has changed nothing in my behaviour patterns over the years I do not believe that I am suddenly feeling guilty and therefore displaying these symptoms). In addition the symptoms died down almost completely and I had almost forgotten about them, when for no apparent reason they have flared up again.
Interestingly (and scary) is that in one case, although blisters were absent HSV2 was in fact diagnosed.
Dr Rock is you take the time to read the thread I wonder if it would change your opion on any of the cases in this forum.
thanks
The doctor has said that if you obsess about a body part it will eventually begin to itch and you will notice bumps that have always been there as a new symptom. Truer words were never spoken.
There is a Herpes paranoia going on in this country, particularly promoted by Valtrex who would love everyone to be taking suppressive therapy. They are making a billion dollars a year on this drug. I guarantee you they will not be providing a cure for this nuisance anytime soon.
There are plenty of people who have Herpes who just shrug it off and live with it as a skin nuisance/disorder. It's very unlikely that when you see 10 doctors and they all tell you there's nothing wrong, that there really is something wrong. It's all about the need to focus outside of your body in order to begin to get better. Every twitch becomes a possible disease, every itch is Herpes and not just a pimple. There are people who genuinely suffer from Herpes, there are also people who take their temperature 20 times a day. It's really an attitude. You can't be fatalistic.
Those Herpes blood tests don't mean very much because low numbers are often false positives. Plenty of people have been exposed, the likelihood of transmittal with safe sex is small. Sometimes being distracted makes a world of difference. You have to change your focus.