Itching red spots

1 year ago I regularly had unprotected sex with a previous girlfriend. Directly after intercourse on one occasion, a large number of small, round red dots (diamater of the sharp end of a pen) spread evenly across the head of my penis (uncircumcized). Very slightly raised and went away in a couple of days. We immediately tested for all common STDs.  She was negative on everything.  I was positive on HSV 1 & 2 IGM antibodies. Report said this could be due to cross-reaction of antibodies (have previously had the odd fever blister on my lip and one developed on my lip a few days after the blood test). Subsequent IGG antibody testing 3 months later was positive for HSV 1 and negative for HSV 2. The urologist said I was probably okay. Since then, I have had a patch of redness on the top side of my penis glans (glands). Seems almost like a dormant skin problem (I feel maybe related to the issue above). 1 year later I have a new girlfriend.  We had unprotected sex 3-4 weeks ago on a few occasions. Two days after a contact, I noticed tingling and itching on my penis, scrotum and groin. 4 days later (6 days after sexual contact), I noticed about 4-6 red spots (somewhat similar to before) at the tip of my penis. This time itchy. Had another blood test - again positive for HSV 1/2 IGM (combination), and negative for HSV-2 IGG.  I asked for the test to be 'typed' for 1 & 2.  Report came back saying negative this time for 1 & 2 (IFA), saying: "elevated titers to both HSV 1 & HSV 2 may represent cross-reactive HSV antibodies rather than exposure to both HSV 1 and HSV 2." Infectious disease doctor doesn’t think it is HSV, but has not seen the pronounced spots (spots and itchiness come and go – more pronounced after an erection).  No fluid, bursting, bleeding, etc.  Look like small welts - a bit bigger than the size of a dot you would make with a pen, with a mild red rash on the top side half of the penis. Could it be Herpes, Molluscum Contaigiosum, Psoriasis, Scabies, or another condition?

[Alan Rockoff, MD]

No, it doesn't sound like any of those.  It does sound like irritation, nothing more.  The blood tests re all consistent with your not having herpes.  1% hydrocortisone and good lubrication during sex should suffice.  You might want to consult a skin doctor.  One visit should do.  Bringing crisp digital photos to the visit may help, in case the rash is not fully present when you go.

Take care.

Dr. Rockoff