Please help...herpes...folliculitis...something else?

[Wolf66]

I first noticed two small red marks on the base of my penis in the hair area.  At least one of them had a hair growing through the center.  I went to the doctor and saw a nurse practioner the next day (Friday) who diagnosed it as folliculitis and started me on Keflex.  However, the next day (Saturday) I broke out with more and several (8-10) on the shaft of my penis including one on the tip and a few on the rim.  They looked like inflamed small red dots (1-2mm) and some looked like a red dot with whitish pus underneath.  Also, I noticed my lymph nodes in my groin were tender.  I went back to the physician two days later (Monday) to get re-examined and the practioner brought the doctor in to examine me.  Some were like small single ulcers with a scab (not connected) and others just looked inflamed with a red dot (scab).  There was no cluster of clear fluid blisters, but the ones near my penis head were a bit painful.  These did not have hair follicles.  Once again they believed it to be bacterial, and after the doctor removed one of the scabs, they swabbed it for a culture test.  I went back five days later and some appeared to be healing although I noticed another one or two in the original site in my public hair near the base of my penis.  The culture test came back normal and they continue to prescribe Keflex.  Although I had some sensitivity with these lesions, I did not have any urination pain.  I've been in a monogamous relationship for the past 1.5 years and have never seen anything like this before.  Also, at times, the ones near my public hair itch somewhat.   What should I do?  Should I just go with their recommendation based upon their visual examination and the swab test?  Should I go back and demand an HSV type blood test?  I know that I am a worrier when it comes to various medical conditions.  If they were right in their initial diagnosis, I don't understand why I have some of these scabs in non-hair areas?  Also, I thought folliculitis was completely painless?  I've read so much about herpes lately and there is a classical look which doesn't seem to fit me, but then I've seen other variations mentioned as well.  Sorry to ramble on.  What is your best guess with this information?  Thank you.

[Alan Rockoff, MD]

My best guess is that they are correct and that this is bacterial.  It does not sound like herpes or an STD to me either, and besides, herpes would be likely to dry up and go away in the time frame you describe, rather than develop elsewhere.  Having said this, I can't really be sure from a distance, so you ought to continue to follow up with your doctor and nurse practitioner.  Meantime, be sure not to pick at or squeeze the spots, because this will confuse the issue when they look at it.

Best.

Dr. Rockoff