Concern about red bump in pubic region

I'm a 30+ year old male that had protected oral / vaginal with a CSW 15 days ago.  I was was careful to avoid skin to skin contact.  I could see the end of my condom during our activity the whole time.  However, I have been with other CSW's (always protected) in the past (last time before this was late Nov).  4 days ago (11 days post activity) I noticed what appeared to be a pimple in the upper left area in the pubic hair.  It's about 1 inch down from where the hairline starts and close to the crease of skin where the upper leg meets the groin.  Because there's a level of anxiety associated with this I have probably checked too much.  I did find another comparable bump closer to the scotum but it was nearly impossible to see because of all the hair.  The red bump in question is 3mm x 1mm oval shaped, red/pink, a little shiny, no whitehead, and slightly raised.  There is no dimple as far as I can tell.  This bump hasn't really changed in appearance over the past 4 days so I think HSV is essentially ruled out, plus...no clusters, no pain, no blisters, no sores.  I initially thought it was folliculitis or some other benign skin condition (pimple) but it hasn't cleared up and although it's near hair, there is no hair sticking out of it.  Are genital warts red in color and do they appear in singular form that far out in the pubic region?  What about MC?  Those are the only two STD's I thought this might be.  Is this something that requires evaluation/testing?  Please note I was tested with a full panel last May and was negative for everything (HSV 1, 2, HIV, Sph, Gon, Cl).  I'm in a committed relationship and I recognize this behavior needs to stop...I hope I didn't destroy what could be a good relationship.  I hope it's just folliculitis.

[H. Hunter Handsfield, M.D.]

Welcome back to the forum.  Thanks for this question.

Within the context of your basic decision to have extramarital commercial sex, you're going about it with maximum safety.  Consistent condom use is highly protective; by itself, it suggests your current problem isn't an STD.  And it seems you also get general STD screening from time to time, which I recommend you continue (e.g., once a year) even if there are no apparent lapses in sexual safety.

You nicely list many of the features that go into visual diagnosis of folliculitis, herpes, molluscum contagiosum, and warts.  But before I get into it, I suggest two bottom lines:  First, I'm betting on folliculitis, i.e. that you have no STD; and second that if the lesions don't resolve within another week or so, as folliculitis would usually do, you'll need to be professionally evaluated.  With or without my help, don't expect to come to a definitive answer without professional diagnosis.

From your description, I agree we can pretty reliably dismiss herpes, for which an initial infection would rarely cause only 2 lesions spaced so far apart.  And the desciption itself doesn't suggest the superficial sort of blisters characteristic of herpes.

I would also dismiss warts, which are not inflammatory -- i.e. the redness is strongly against warts.  And as you suggest yourself, the location in the pubic area also is atypical.  Molluscum contagiosum sounds plausible, and fits with the location, and is suggested by the "shiny" character you describe; dimpling often takes a while to develop as lesions mature.  On the other hand, there are only 2 lesions (so far); usually there are more.  Your age is also against MC, which is most common in teens and early twenties, quite a bit less so over age 30.

The timing of the sexual exposures doesn't help much.  Both warts and MC typically would at least several weeks after exposure (for warts, the average is 6-9 months).  If you have either of these, you didn't catch it from the specific CSW exposures described.

As implied above, neither warts nor MC will go away within 1-2 weeks, but folliculitis will.  If that's what happens, I think you can safely forget the whole thing.  But if the lesions persist, or if additional ones appear -- and obviously if one or more lesions develops a central dimple -- see a doctor or clinic, ideally a dermatologist or STD specialist.

I hope this has helped.  Best wishes--  HHH, MD

[marty522]

The bumps i asked you about cleared and I assumed all was well.  Most recently I got one red bump on my inner thigh, a little towards the back just about where boxers shorts would end.  It looked like a pimple with a small white tip and I naturally tried to pop it. Of course, I couldn't pop it and it led me to question if it was a pimple at all. It's about a week old (maybe less), no dimple, red and inflamed.  Since MC was the only plausible STD we discussed, can you get it on the backs of your thighs?  I'm betting on folliculitis again, but just nervous.