Balanitis?

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I suppose I have become hyperaware of things going on "down there" lately.

I'm a male in my 20's. Always practiced safe sex (condoms) with anyone of unknown STD status. Only unprotected sex prior to this was either with virgins or a longterm girlfriend (last ex) that was tested (along with me).

Current girlfriend gets tested about 4 times a year. She has also used condoms with everyone but one partner. She had sex with him twice without condoms. He had been with 2 girls in monogamous relationships before her.

She was tested in May. I asked her to call her doc and see what  test she'd be using, and the nurse said "Herpes 1". That doesn't make sense to me, what I'm thinking is that it was a non-type specific test they were giving her (IgM). From what I understand, there would be no reason to do a Type 1 specific test?

We had sex 5 wks ago on the assurance that she had never had symptoms and clear test results. I have no reason to doubt her honesty.

Maybe 36 hours after the first time we had sex unprotected, I noticed a red rash with pinhead sized red dots right under the glans to one side. We had sex that morning and I didn't wash, and had tight pants on and it was very hot out (95 degrees and humid). We spent a lot of the day outside and walking. There was slight redness on the other side, but not nearly as noticeable. It would fade a bit, but come back either after sex or masturbation. Reading a bit too much online, worried about herpes, I decided to go to my dermatologist. He took a swab and said it was balanitis and not to worry. He seemed confident about it. Gave me an RX for anti-fungal cream and cortisone cream and sent me on my way. It cleared up before I filled my Rx on those. It has not recurred in the same spot.

I still was a little concerned. She was nice enough to go out and get a Biokit test (I think that's what it's called). The 10 minute finger ***** test for HSV2. That was approx. 2.5 months after her last boyfriend and her broke up. It came back negative. She did have a UTI and was treated with antibiotics. No pain while urinating for me.  

The next time we had sex, I did get irritation again a bit after a lot of sex. Not in the same exact spot but close. I also got some white heads in the pubic region above the penis, maybe 1-2" from it. They had hairs coming out of them and I know that whiteheads never appear from herpes, so it only concerned me slightly. I think it may have been due to the sex, sweating, and skipping a day of showering afterwards.

The derm results were positive for fungus. There was also a little bacteria mixed in.

Well I did notice another red spot recently. I think it's been there about a week. It's right on the rim of the head on the other side. Just a tiny red area with a pinhead sized red dot. Comes and goes from contact. After a day of no contact it fades, but still faint. Am I right to think herpes would not present like that?

I know it's tough to diagnose online, but would you agree with

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Doctor, recently, maybe 4 hours after sex, I had what appears to be  an inflamed hair follicle with another, less inflamed one maybe .5" from it on the back of the shaft of the penis, where I have some hairs. It looks like a red pimple, cone shaped I suppose. There is a hair sticking out of the center, you can see the "bulb" at the center of this inflammation when the hair is pulled on both. I also had one very similar appear on my inside leg the night before, where my scrotum would have been in contact. The area on the penis is also where the scrotum would have contact at certain times. I have bad jock itch at the moment and am wondering if it's all related.

Just to be clear, herpes never presents as a random inflamed hair follicle, correct?

I also was pleased to find out that my partner's last sexual partner (2.5 months ago as mentioned) was tested clear, so her last "unknown" was over 4 months ago, and she always used a condom with anyone of unknown status. So I'm pretty sure she's near 100% in the clear, but I still worry when I see these things.

Thank you for answering all my questions. This is a great service you provide.

[H. Hunter Handsfield, M.D.]

Yes, you can be confident your partner doen't have HSV-2.

HHH, MD

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Well, the derm just gave me some anti-bacterial foam for the pimples and said if it got better not to be concerned. They cleared up after a couple days with the foam.

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I'm sorry for the addendums, but it should be noted that the derm results refers to the first visit in which he swabbed the first red area I noticed. Just wanted to make sure I was clear on that.

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Also (last question and I will go my merry way), given her multiple negative IgM results and negative HSV2 finger ***** test approx. 2.5 months after last sexual partner, would you say it's pretty safe to assume she's clear?

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Hmm, the end was cut off. Meant to say "do you agree with his diagnosis?"

I should also mention none of these spots ever really caused any itching or pain. Never erupted or became "open". I guess the first rash looked a little "raw" after contact (like in some spots the first layer of skin eroded), but again that was only after rough contact. The whiteheads I popped were a bit sore for a day or two, but that's expected.

[H. Hunter Handsfield, M.D.]

Since you have seen a dermatologist who doesn't think you have herpes, was confident you don't have herpes, and you tested positive for the most common cause of balanitis, that is what I believe you have.  Your symptoms don't especially sound like herpes but are entirely consistent with nonspecific or fungal balantitis.  You and your partner don't need any further testing for herpes.  Follow your dermatologist's advice about treatment and follow up.  (The white heads almost certainly are folliculitis or garden variety pimples.  Your dermatologist also is the best source for further advice about that problem.)

Good luck--  HHH, MD