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Dermatology (Expert Forum)
Red scrotum, then blisters...is it Herpes?
Answered by
Alan Rockoff, MD - dermatology, Child Skin Problems
The Rockoff Dermatology Center
Brookline - MA
This forum is for questions regarding Dermatology issues, such as: skin rashes, acne, birthmarks, skin infections, rosacea, and general skin care.
Red scrotum, then blisters...is it Herpes?
by IraqDale, Mar 21, 2005 12:00AM
I am a 25 year old male, and about 1 year ago I noticed a red abrasion on my scrotum above my right testicle. I thought it was just that, an abrasion, and didn’t pay it much attention. In less than a week, the red abrasion had spread across my entire scrotum. Figuring it was jock itch I bought a jock-itch spray and a jock itch cream. That made the inflammation much worse. A few days later, yellowish blisters broke out across the right side of my scrotum, where the abrasion first appeared. Because of the blisters, I thought herpes and ran to the doctor. He laughed at my concern and did not conduct a viral culture or a blood test, saying that it was simply a fungal infection, and prescribed Mentax to me, a topical anti-fungal. I applied the Mentax as directed, and everything cleared up. The life-cycle of the entire thing was about 2 weeks.
Well about 3 months later I found myself in Kuwait and in 125 degree temperatures, I noticed the same redness beginning over my right testicle. I went to our PA and asked him for some anti-fungal cream. He gave me cream and a powder, which I used over the next month, but to no avail. The redness spread over my entire scrotum, and persisted for another two months. We tried every anti-fungal we could, including Diflucan. I even tried Mentax again, which seemed to have worked so well the first time, but this time nothing improved. After about 3 months since the redness first appeared, I again broke out into blisters across the right side of my scrotum. The blisters were painful to the touch. Prior to the blisters, however, nothing was really painful or itchy. I showed the blisters to my PA who was confused by the whole thing, but remarked that the blisters did “look herpetic.” I went to my battalion doctor, an actual MD, and showed him my break out. He did not think it was herpes, but suggested folliculitis. He gave me antibiotics. A few days after the blister outbreak, everything cleared up and went away, just as it had the first time. The doctor congratulated himself on having correctly diagnosed the bacterial nature of the condition, just as the 1st doctor congratulated himself on having diagnosed the fungal nature of the condition, each believing that the medicine he prescribed was responsible for the clear-up. I think, however, that whatever it was had just run its natural course and cleared up, independently of the medicine.
After the second outbreak, my scrotum appeared to remain redder than usual, but the redness was not all that noticeable and I didn’t have any trouble with anything for 5 more months. Then, just a few days ago, I noticed that all-too-familiar red abrasion on my scrotum above my right testicle. I’m worried that the cycle is beginning all over again and, even worse, I have no idea what it is. The existence of the blisters worries me, and obviously I am still thinking about herpes. At the same time, however, my gut tells me that it isn’t herpes. First of all, I don’t think it would manifest like it did the second time: as months and months of redness followed by a 2-day break out of blisters and then mysteriously disappear. Also, I don’t know how to explain it, but although the blisters were separate and distinct, they did not seem like sores. They were more like something that affected just the surface of the skin. One time when I was young I was sunburned really badly on my arm and water blisters formed. It reminded me of that.
Now, I was diagnosed with Molluscum about 6 years ago. It was in my pubic region, and I’ve been battling it ever since. For the last year I have been treating it with Aldara. Every time I’ve had a break out on my scrotum, I have used Aldara sometime within a close time frame to that break out. However, if it was the Aldara that caused it, I don’t know how the Aldara would have gotten from my pubic region on to my scrotum.
What do you make of the outbreaks of redness and, ultimately, blisters? In the absence of a viral culture, what would a blood test for HS2 do for me? If the blood test does not detect any HS2 anti-bodies, does that mean, definitively, that I don’t have HS2? Does the presence of HS2 anti-bodies conclusively show that you have HS2? Lastly, about my Molluscum, does that fact that I’ve been continually having break outs for 6 years, without developing an immunity to it, suggest that I may be immunocompromised?
Well about 3 months later I found myself in Kuwait and in 125 degree temperatures, I noticed the same redness beginning over my right testicle. I went to our PA and asked him for some anti-fungal cream. He gave me cream and a powder, which I used over the next month, but to no avail. The redness spread over my entire scrotum, and persisted for another two months. We tried every anti-fungal we could, including Diflucan. I even tried Mentax again, which seemed to have worked so well the first time, but this time nothing improved. After about 3 months since the redness first appeared, I again broke out into blisters across the right side of my scrotum. The blisters were painful to the touch. Prior to the blisters, however, nothing was really painful or itchy. I showed the blisters to my PA who was confused by the whole thing, but remarked that the blisters did “look herpetic.” I went to my battalion doctor, an actual MD, and showed him my break out. He did not think it was herpes, but suggested folliculitis. He gave me antibiotics. A few days after the blister outbreak, everything cleared up and went away, just as it had the first time. The doctor congratulated himself on having correctly diagnosed the bacterial nature of the condition, just as the 1st doctor congratulated himself on having diagnosed the fungal nature of the condition, each believing that the medicine he prescribed was responsible for the clear-up. I think, however, that whatever it was had just run its natural course and cleared up, independently of the medicine.
After the second outbreak, my scrotum appeared to remain redder than usual, but the redness was not all that noticeable and I didn’t have any trouble with anything for 5 more months. Then, just a few days ago, I noticed that all-too-familiar red abrasion on my scrotum above my right testicle. I’m worried that the cycle is beginning all over again and, even worse, I have no idea what it is. The existence of the blisters worries me, and obviously I am still thinking about herpes. At the same time, however, my gut tells me that it isn’t herpes. First of all, I don’t think it would manifest like it did the second time: as months and months of redness followed by a 2-day break out of blisters and then mysteriously disappear. Also, I don’t know how to explain it, but although the blisters were separate and distinct, they did not seem like sores. They were more like something that affected just the surface of the skin. One time when I was young I was sunburned really badly on my arm and water blisters formed. It reminded me of that.
Now, I was diagnosed with Molluscum about 6 years ago. It was in my pubic region, and I’ve been battling it ever since. For the last year I have been treating it with Aldara. Every time I’ve had a break out on my scrotum, I have used Aldara sometime within a close time frame to that break out. However, if it was the Aldara that caused it, I don’t know how the Aldara would have gotten from my pubic region on to my scrotum.
What do you make of the outbreaks of redness and, ultimately, blisters? In the absence of a viral culture, what would a blood test for HS2 do for me? If the blood test does not detect any HS2 anti-bodies, does that mean, definitively, that I don’t have HS2? Does the presence of HS2 anti-bodies conclusively show that you have HS2? Lastly, about my Molluscum, does that fact that I’ve been continually having break outs for 6 years, without developing an immunity to it, suggest that I may be immunocompromised?
Doctor's Answer
by Alan Rockoff, MD, Mar 21, 2005 12:00AM
, Mar 21, 2005 12:00AM
If by blisters you mean actual fluid-filled bubbles, then this may indeed be herpes. A culture at the time the blisters reappear would be definitive. Otherwise, a herpes 2 IgG test can be very decisive either way--a negative test means you don't have it, a positive one means you do. For reliable tests, see www.herpesdiagnosis.com.
I don't know what it means to "battle molluscum" for 6 years, as I have never seen this happen. I am skeptical that this diagnosis continues to be correct, even if it once was. I advise another dermatologic opinion.
Take care.
Dr. Rockoff
I don't know what it means to "battle molluscum" for 6 years, as I have never seen this happen. I am skeptical that this diagnosis continues to be correct, even if it once was. I advise another dermatologic opinion.
Take care.
Dr. Rockoff
