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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
Welcome to the DERMATOLOGY FORUM! Questions in this forum are answered by Dermatologists from St. Luke's Roosevelt Hospital, under the direction of Andrew Alexis, M.D., M.P.H.
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
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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.
Why do you think I haven't gone back to the doctor? Believe me I would never be on this website otherwise.
I am slowly coming to terms with the fact that I don't have herpes, I have never had the blisters (which I am lead to believe are always present in the first attack) and the symptoms have gone on for months (and nowhere have I read that this ever happens and believe me I have read and spoken tons on the subject). It sounds like you too have had the symptoms for months, no blisters (and oh yes HSV1 blisters as well)so like me I think (and hope and pray) that you have something else - either real or from the stress of believing you have herpes.
I am not fully convinced I did not catch something - and there is plenty of literature to suggest that the symptoms we have can be caused by a variety of things (and yes mental anguish is one of them but there are others). What to do? Well I am planning to have a full STD work up and once I get the results of that I have convinced myself that I need to believe the results and move on. The psycholgical efects of what I /we have are far more damaging than a patch or red itchy skin (which if it were anywhere else other than on our genitals would not worry us at all) - so good luck and keep the faith! Let me know how it turns out.
Dr. Rockoff
Boy did I read the sites on Herpes. Some of them scare you so bad you don't even want to think of it - I lost sleep. Every 30 seconds a Valtrex ad came on TV. The CDC had stats on it...1 in 5 have it, and 85% don't know that they do, etc. It's amazing what information overload will do to you. For me, it just stressed me out even more.
I saw how Dr. R recommended 1% hydrocortisone for ecezema - I prayed that maybe, in light of all these facts, that this could be what I had. It did relieve the itching, within 24 hours. The only concern I still have is a general redness/heated skin on my scrotum that still exists. There is also an occasional itch - but again, no blisters or anything of that sort.
I am still trying to muster up courage to go get an offcial blood test, as doubts still run through my mind. But reading the comments alone from you all on this post has also helped ease my mind, because it's reassuring to know that others have the same obsession as me.
For you, you have had multiple Dr's diagonose and confirm that you are clear. Go on and enjoy your life - and know that others have the same worries as you and are also trying to clear their minds. What the folks have said on this post (tony/electra) are good and should ease your mind, not to mention Dr. R.
Best of luck to you,
worryman
I MUST ADMIT AFTER THE TEST CAME BACK NEGATIVE(WESTERN BLOC IS THE GOLD STANDARD WITH 98% ACCURACY),MY OTHER SYMPTOMS STARTED TO CEASE ALMOST IMMEDIATELY.
WHAT A MIND TRIP THIS HAS BEEN. I HAVE LEARNED FROM THIS EXPERIENCE THAT THE MIND CAN INDEED CAUSE PHYSICAL MANIFESTATIONS. I AM MOVING ON...FINALLY.
MY THANKS TO DR. ROCKOF
I was diagnosed with HPV about 5 months ago and was prescribed Aldara 5% to treat the warts. I had never been diagnosed with an STD before and had always been quite careful about my sexual partners and relations. Due to the nature of the condition, it had been quite difficult for me to trace back exactly where i had contracted it and when.
Although the cream worked wonders on an external wart, near the base of my penis, i developped an unsightly reaction on the head which I consider internal, as i am uncircumsised and the area is very sensitive. After turning red the skin began to blister and open up leaving a cluster of sores where Aldara was applied or spread to overnight.
My first reaction was to consult the manufacturer about side-effects of the drug, and i found that there were small possibilities of this being a normal side effect. Unfortunately, i had accidentally come across a picture of genital herpes online and to my abolute dismay, IT LOOKED EXACTLY LIKE MY SYMPOTOMS!!
After freaking out for a couple of days, i went to see my doctor again and had a viral culture test done. Over the next two weeks i also developped, or think that i developped prodormal symptoms such as tingling in the legs, pressure in the groin, red bumps on my thighs, butt and groin as well as an occasional lower backache. Fueled by the vivid descriptions on herpes info websites and user boards i was mentally preparing myself for the horror of having the test return positive and dealing with the consequences.
To my surprise not only did the test come back negative, but the prodormal symptoms continued. I had never again had a breakout of sores, nor anything remotely similar, but i now frequently experiences tingling in the legs and thigs, an itchy groin rash, and strange bubble-like pimples at the base of my penis. These did not go away for a week, and when popped, they scabbed up and took very long to dissapear. I had also spotted a couple of these on my thighs, although these bubbles were smaller, filled with pus, and accompanied by a larger reddened base.
In addition, the prodormal symptoms as described above occur in cycles, about once every 10-14 days. At the onset of a new cycle, i notice significant leg tingling, new pimples/bubbles or enlargenment of older ones, occasional lower back aches, and a shedding of penis glans skin. After masturbation (i've sentenced myself to abstinence until i figure this out), when the glans skin is exposed for a significant amount of time, i notice substantial dry tissue, flaking and skin shedding. I find that this happens especially during times when i am experiencing other sympotoms such as leg tenderness or new pimples.
1.) Could these be symptoms of herpes? From what i have gathered from various info sources, these could be symptoms of a dormant infection, one which is contagious but not strong enough to bear true HSV2 symptoms.
2.) Could these be symptoms of genital HSV1 herpes? I have personally never had an HSV1 or 2 infection, but a former partner has recently informed me that she has had recent outbreaks characterized by lip sores.
3.) Aside from the possibility of serious hypochondria, could this be attributed to anything else?
I am currently trying to find a clinic or willing doctor who will perform the Western Blot, but seeing that i live in Canada i am finding it extremely difficult. I have found most of the doctors and health professionals which i've consulted on this issue to be either blatantly incompetent or uncooperative and am seeking a refreshing and informative expert source on the issue.
Please help,
Paranoid about Herpes.
The doc doesn't answer unless you pay so you may want to repost your question directly to him. In the mean time my advice is try your hardest to leave the area alone, don't examin it, don't touch it and don't wash it too much and see what happens.
I respect doctors for all their knowledge and wisdom,
but I have learned over the years, how to listen to the
best Doctor (God) within me. This should never replace a medical
professional but it is important, nonetheless.
I knew something was not right with my penis.
Even though, symptoms were mild, they were persistent.
I told my doctor, I thought it was herpes.
He took a quick glance and said no. I was a little comforted by his words but also skeptical. I asked for a blood test.
2 weeks later, I was his office again. He hadn't called me to come in for the results. So I made an appointment on my own.
He told me "You did not have to come back unless we called you"
In other words, "why are you here again?".
He told me that they were having trouble locating my folder.
I showed him my penis again, and he said "It doesn't look like herpes to me, but I'll give you an itch cream. If it doesn't work
I'll refer you to a dermatologist."
He came back a few minutes later with the test results.
I was explaining to him why I thought it was herpes, and in the
middle of the conversation, he non-chalantly, says "the tests came back positive for herpes I & II".
He was having a very busy day, and gave a quick pep talk, then he asked "any questions?"
I was still in shock. I walked out of the office in shame and in shock. That was a couple weeks ago. i just wanted to share that.
Maybe, someone can relate.
If i may ask, what were your symptoms and to what extent were they mild?
Thx,
I think it's important to remember that.. people with herpes get zits/eczema/rashes/whatever else on their genitals, too.
Just because someone has a rash or a zit on their scrotum, and a blood test shows a postive result for herpes II, it doesn't mean that the rash/zit/whatever else was actually caused by herpes.
Hopefully that makes sense.
What I don't exactly understand is the personal accounts where people just have zits or rashes on their genitals, and a swab test or biopsy is done, and it comes back positive for herpes. That would kind of go against the accepted idea that herpes only causes blisters. Perhaps it was a small blister, perhaps it was clusters of really really small blisters, perhaps they just lied. Who knows. I don't actually even know if "clusters of really really small blisters" are even possible, but hey. I think it'd be interesting if the Dr. could ever comment on this, just to clear things up. I don't exactly know what to believe at this point as far as the "herpes only presents itself as blisters" deal goes, but as of now I pretty much believe Dr. Rockoff.