Follow up question to Herpes/Scabies question of 7/28

[WorriedandSick]

Thanks Doctor for your response on 7/29.  I have a follow up question if you don't mind.  The Permethrin seemed to work for a while, the itching in my hands and penis went away and the scabies marks on my hands healed nicely.  The skin tears on my penis shaft improved and felt better but never fully have healed yet, although the itching went away after treatment.  THEN I had a recurrence of the signs of scabies in my hands last week (about 2 weeks after initial treatment), not as severely, so retreated all over with permethrin Thursday and they seem to have gone away, but the itching/stinging in my penis and those skin tears seem to have gotten worse again.  Naturally, i don't know what to do-- I spoke to the dermatologist and he still thinks scabies are the cause and that I got reinfested by the sheets or because my partner didn't treat herself (she said she had no signs of scabies and had had them once long ago, so knew what the signs would be). He says that the scabicide is pretty much 100% effective otherwise.  I am still worried that this could be a correct diagnosis of Scabies on my hands but that it could still be herpes on my penis.   The little skin tears --10 or so of them are about 1/4" to 1/3" long and run somewhat parallell to each other along the skin underneath the shaft of the penis where it is bunched up where the scar from circumcision is, also parallel to my penis.  they itch/sting a little bit, but no sign of any oozing, blisters, or blood-- just slightly shiny "underskin" where the tears are.  What do you think?  As frame of reference, it is now over 6 1/2 weeks since initial itching on the penis and appearance of scabies tracks on hands and over 8 1/2 weeks since possible exposure.  I have to admit that i am confused by all the information on the internet about herpes as to signs, duration, and severity of inital outbreaks, as many descritipns are vague and extremely general.  I would imagine that 6+ weeks is a long time for there to be an ongoing outbreak (athough this could then be a 2nd outbreak for all I know!) and that the symptoms, but for the tearing and itch/pain don't match well with herpes-- I have never had any fever, or swollen glands down in my genitals, but of course in my anxiety I am imagining all kinds of things!  Please advise, and thanks again!

[Alan Rockoff, MD]

The dermatologist is correct to say that permethrin has a high cure rate for scabies.  I therefore doubt very much that you need to, or should, use it again.  In my experience, patient treated foe scabies often continue to itch for a while afterward.  In most cases, this does not mean that the scabies are still there, even if the itch makes it feel as though they are.  Incidentally, sheets are most unlikely to spread scabies.

As to the teats and "bunched skin," on the penis, I don't know what to make of them.  They sound unrelated to herpes or scabies.

For further information on you case, I refer you to your dermatologist.  There is little further useful for you to gain from the internet, in this forum or elsewhere.

Best.

Dr. Rockoff