Genital Sore

Doctor,

I have discovered an ulcer-like sore on my penis that has been there for about a week.  I didn't observe a blister in the area prior to seeing the sore.  I haven't had sex for about two months - before that, I was with my ex girlfriend exclusively for over two years.  She had a herpes test early in our relationship and tested negative.  However, I have had cold sore flair ups for as long as I can remember.  We avoided oral sex due to my fear of transmitting herpes to the genitals, however, we did have oral sex on a few occasions (never while I had a cold sore).  

Also, I have been treating myself for genital warts with Imiquimod for the past few weeks (This is a separate matter - I knew my ex had had warts in the past while I was with her).  Is it possible that Imiquimod has caused this sore? Is it irrational to believe that this could be genital herpes, due to the length of time that has passed since I last had sex and the exclusivity of my prior relationship? I'm trying to get an appointment with the dermatologist who prescribed the Imiquimod, but I'm afraid the sore will have healed by the time I finally get an appointment.  Please let me know what you think.

Thank You

[Alan Rockoff, MD]

Imiquimod can cause irritation and ulcers, so you should stop it.  Herpes is possible, because a recurrent-type herpes (like a cold sore of the lips) can come long after exposure.  But your description does not sound like herpes.  I suggest you make your earliest appointment, and take along a good photo of the ulcer as it is now.  But stop the imiquimod, and don't treat yourself for warts you may not have.

Take care.

Dr. Rockoff