Herpes, Follliculitis, or Staph

I noticed a bump on the top part of my buttocks last Saturday (4/24/2008) but disregarded it because I figured it was acne.  Two days ago (4/28/2008) I noticed some pus in my underwear and the bump had crusted over.  Let me also tell you that I am a dancer and recently had an exhausting weekend of performances following an intense week of rehearsals in which I didn't wash my tights or leotard as often as I probably should have.  I'm fairly hair back there and have a tendency to sweat a lot.  I decided to go to the doctor yesterday (5/1/2008) where she immediately suspected it may be herpes or a staph infection.  She completed a culture and blood test which would not be returned until sometime next week.  Dissatisfied with her potential diagnosis, I headed to the ER of a local hospital where the doctor asked me my sexual history.  I explained to him I had the same sexual partner for 4 months now in a monogamous relationship in which neither of us had shown symptoms of herpes simplex 2 before.  I also explained that the last time I had sexual intercourse with a different partner was some 7 months prior to that and had no symptoms up to that point.  He explained that, typically, a sore of HSV 2 would occur 7 to 10 days after exposure.  Though I do get recurring fever blisters, one of which I had immediately prior to the bump on my butt, I asked if transmission may have occurred from the towel I use to dry off with...which he said may have happened, but in most cases it happens from skin to skin contact of an infected person.  Likewise, he asked if it hurt...I told him that it's barely noticeable and feels like an infected hair or acne...noting excruciating, which he said would be the case with herpes.  He explained that patients are in a lot of pain with herpes from it since its basically an open nerve ending...and when the first doctor did the culture, it felt like she was just scraping the sore, noting too uncomfortable...which he also said was not indicative of herpes considering the pain most diagnosed HSV 2 patients are in.  He suggested that a staph infection or MRSA seemed unlikely too since it usually spreads very quickly and is worse looking than my place, which looks basically like a scrape or popped pimple.  After explaining what I do for a living, he figured it would be folliculitis...based on what I've described, any guess on your behalf?

[niftynurse]

I too have had almost exactly the same thing occur (on my butt cheek) not too long ago. I treated it with Physiodermie Anti Impurities Bioarme since it has antibacterial properties and it was gone within three days. I am an RN and I have seen the exact same "purplish pimple" on some of my MRSA and staph infected patients. After doing some research, I came to realize that MRSA and staph infections are far more common than previously suspected and that some people's infections even go away. I believe there was even a study on it up north at a pig farm where people kept getting staph infections.
Anyhow, Could be folliculitis, could be MRSA could be staph infection...could be folliculitis that became infected by staph. Alot of people are asymptomatic carriers of staph.....
I guess I am really no help at all to you. Just basically wanted to let you know that you aren't alone!

[Bhupinder Kaur, MD]

Hello,

I fully agree with the ER doctor that herpes is a less likely but not impossible possibility. Most individuals have no or only minimal signs or symptoms from HSV-1 or HSV-2 infection. When signs do occur, they typically appear as one or more blisters on or around the genitals or rectum. The blisters break, leaving tender ulcers (sores) that may take two to four weeks to heal the first time they occur. Typically, another outbreak can appear weeks or months after the first, but it almost always is less severe and shorter than the first outbreak.

Herpes also presents with red itchy blisters which scab over. Herpes simplex is most easily transmitted by direct contact with a lesion or the body fluid of an infected individual. Transmission may also occur through skin-to-skin contact during periods of asymptomatic shedding.

The only way of ruling it out is by getting yourself tested for genital herpes. Laboratory tests include: culture of the virus, direct fluorescent antibody (DFA) studies to detect virus, skin biopsy, and polymerase chain reaction (PCR) to test for presence of viral DNA. I sincerely advise you to consult a dermatologist and get it ruled out.

Hope it helps. Take care and pls do keep me posted on how you are doing or if you have any additional queries.Kind regards.