Red Bumps in the "Boxer Shorts Region"

I am a 27 year old, sexually active male who has just become anxious at the continual formation of Stage 2 ulcers (under the Raghavendra manual classification) without the blistering in the "boxer shorts" region of my body. I have had this problem for several years but cannot remember when I first noticed them. I remember swearing off lotioning my buttocks because several ulcers had formed there and I thought it was because of that. I have been reading information on the Herpes Simplex Virus-2 and most have definitions of the classic symptoms and neither symptom seems appropriate to my condition. My ulcers become red, swollen, sometimes drying the skin and peeling away at the edge and sometimes at the center, and go away after 2 or 3 days, leaving behind a scar of red skin. From the information on HSV-2, I assume the breakout happens in the same area for each occurance and that there is a cluster of ulcers gathered that itch, burn, and are painful, just like a Cold Sore. I have never had that symptom, but the information also states that people with HSV-1, which I have, will have minimal symptoms of the HSV-2 virus. The ulcers I get are fairly normal and only one pops up with no "prodrome" session, which again lasts for 2 or 3 days, subsides, and leaves a red dot. These ulcers also happen on either side of my "boxer shorts" region, specifically on my pubic mound, my thigh, my waistline above my buttocks, and on the buttocks themselves. Are the symptoms I am exhibiting the same as those of an STI or STD, or are my symptoms strictly dermatological? Do I have a skin infection of some kind? Does HSV-1 or HSV-2 affect moist areas of the genitalia or only the larger skin areas surrounding?

P.S. I remember several times over the years when an ulcer would look like a blister or pimple and rupture, with my tinkering with it. Cloudy, white liquid, not unlike those in pimples, would ooze out, coupled with blood, so it seems as if these ulcers have a "root" deeper than those of the Herpes virus. The ulcers also are not painful, unless they are like ones that are described above and of those most have been on my pubic mound. I had an initial STD screening about 4 years ago, which stated I was clean, and am having one again in 2 weeks. I have only been with 3 partners in the last 6 years, with a little over 9 months between my 2nd partner and my latest, and over 5 years between my first and second partners.

I know I won't be fully diagnosed until I see my doctor, but I would like some help in being steered in the right direction. Thanks Doctor.

[Vanessa Lacuesta]

Hi

In the presence of a significant sexual history, an STD will always be a differential unless proven otherwise. In your case however, it is necessary to note that HSV infections are not always STD's. They are transmitted through direct skin to skin contact. Even patients who do not show any blisters may shed the virus for 2 years and thus, may transmit infection.

I feel that you are worried about this. In your case, a superficial skin infection may also be likely here. A fungal infection with an underlying dermatitic skin condition may be present. This may explain the discharge and the persistence of the skin rash for greater than 6 months.

You need medications for this. A topical antibiotic or corticosteroid may be able to help. Culture and sensitivity tests of the discharge as well as gram staining or microscopic evaluation of the discharge will be able to help guide treatment.