Could it be herpes or bacterial??

[freakinout369]

I am a heterosexual male in my late 20's. Back in late 2005, I had unprotected sex with a girl I had been dating for about two weeks or so.  We had sex three times in one night (not oral or anal, just vaginal).  Intercourse became rough at times.  We finished around 12:30pm that night and when I woke up the next morning, I had red bumps in my public hair region.  They were rather large in size... about the diameter of a dime and they were maybe 1mm in height (reminded me of hives).  About two hours later that morning, I noticed one at the base of my penis and then one on the left side of my shaft.  That next morning, pretty much all the red bumps had disappeared except for the one on the shaft and at the base.  I noticed the one on my shaft had a white head on it, looked like a pimple.  Like an idiot, I popped it and clear fluid and a little blood came out.  I put some neosporin on it and hoped it would go away.  The bumps were there for another two weeks or so and then I noticed another one forming underneath the first one on my shaft.  It got to be about the same size and I saw there were two white bumps on top of this one.  At this point, I made an appt with my doctor... by the time I got to see him (about two days later) I had already gotten a scab on the second bump.  At that point, the first bump already had a scab on it for about a week and a half.  My dr did not know what it was and referred me to a dermatologist.  The derm said it could be herpes but it appears to be a bacterial infection.  Since it was already in the healing process, there was no point in taking a culture. He prescribed some Mupirocin ointment and told me to apply it 3x per day.  When I applied the ointment, it began healing but still took about 4 weeks to completely resolve.  On a few occasions between now and then, one or two red bumps would appear at the base but it had not shown up on the shaft.  I'd put some mupirocin ointment on it and it would go away quickly.  In late march of 2007, a bump appeared back on the shaft (the same place as late 2005) and this time it had 4 single white bumps on a red base.  Red base was about the same size as before.  I put the rest of the ointment I had left on it for about two days and then ran out.  I went back to the derm and he gave me a refill... he wouldnt do a culture because the white bumps were gone and had nothing but scabs. He said they need to do a culture before they can determine what it is. I put the ointment on for a few days until it got better and then stopped.  I noticed I had 4 light patches in my skin where the white bumps were.  This past Saturday (with no warning), I saw the same red bump with 4 white bumps again.  Exact same place it was at the end of march... it's almost like it never fully healed??  I've been putting the ointment on there 3x a day and it appears to heal quicker this time.  Right now, there's a small red area with the 4 scabs.

I went to a different derm today (the other one is out of town) and he literally looked at it for 30 seconds and told me it was a herpes infection and there was nothing I could do about it.  I almost got the feeling I was being stereotyped because I am a single male in my late 20's.  He talked to me like I was sleeping with every woman I come in contact with.  When in reality, my number of sexual partners is less than 10... 8 to be exact.  I've been in several long term relationships, all of the women I've dated have gone to a GYN on a regular basis and have never been told that they had herpes.  

At this point, I dont know what to think.  Would you recommend having a blood test done for HSV?  If so, which one do you recommend?  Most doctors I've spoken to about this say the blood test are not accurate in the least and I shouldnt waste my money.  The past two times the infection has come up, it's been on a Fri or Sat and I cant get an appointment to have it cultured before it begins healing.  Can herpes rolves itself within two days??  Everything I've read says it's 7 to 10 for recurring infections.  I have not really dated in the past year and a half because I don't know what I have and I don't want to infect someone with this... I didnt ask for it and I dont want to give it to anyone either.  I typically masterbate with my left hand and that part of the shaft is rubbed a lot.  Could this in fact be bactieral and look like a herpes infection?  I'm kind of reaching but I don't think the time lines match up with herpes.  If I don't use the antibotic ointment, it's slower to heal.  I figured that antibodics would have NO affect on herpes what so ever.

I know this is a long post and I apologize for that.  Any insight you can give me would be much appreciated. Thank you in advance!  

[H. Hunter Handsfield, M.D.]

You give a mixed story in terms of genital herpes.  Certainly the red bumps appearing the next morning can be due to herpes acquired the night before.  Herpes never shows up in less than 2 days after exposure.  Also, the pubic area--i.e., where there is pubic hair--is an unusual location for herpes, but the primary place where other skin infections (e.g., folliculitis) are common.  Also most herpes of the penis is not at the base, but on the head of the penis or the shaft.  And irritation from rubbing during masturbation doesn't look at all like herpes and really cannot be confused with it.  However, herpes is the single most common cause of recurrent genital lesions that cause scabs, and a dermatologist's opinion in favor of herpes is pretty good evidence.  Still, scabs without blisters or pimple like lesions is atypical.

The 'most doctors' you have spoken with about HSV blood tests are simply wrong.  The solution to your dilemma is a blood test.  See numerous other threads about this; use the search link to look for 'herpes diagnosis' and 'HerpeSelect test' for lots of information.  If negative for HSV-2, it will strongly indicate that your symptoms are not due to herpes; and if negative for both HSV-1 and HSV-2, it will prove it without doubt.  If postive for either virus, then you can follow through with further tests if necessary, such as a culture for HSV next time you have an outbreak.

Are you Canadian, by chance?  That is the one industrialized country in which public health authorities generally have a very atypical and iconoclastic perspective on HSV blood tests.  If so, there are private providers that offer HSV testing.  Or, since 90% of Canada's population is a couple hours drive from the border, visit a clinic in the US.

Good luck--  HHH, MD

[H. Hunter Handsfield, M.D.]

The first sentence of my reply is supposed to say "...cannot be due to herpes...."

[freakinout369]

Thanks Doc, I appreciate your feedback.  Before that encounter in late 2005, I've never had bumps like this before.  I have had red rashes (itchy and flake dry skin) that would appear all over my penis but I went to a dr about that in 2004 and he told me it was jock itch.  Either lotrimin spray or sportslick clears that up in a few days.  You said that herpes does not show up in less than 2 days but in the sentence before you mentioned that the red bumps could have been from herpes acquired the night before?  I wasn't clear on that.  The past two outbreaks, there have been 4 pimples or blister like formations on top of a larger raised red base.  However, the blisters never "pop"... after the second day or so, it simply scabs over.  The antibodic ointment seem to help the swelling and redness go down... am I just being hopefully or is there a bacterial infection that looks like herpes?

I will search on the terms you provided and see if I can schedule a blood test to be performed.  I'd like to get tested for both types 1 and 2.  No, I am from a big city on the east coast (US).  But every doctor that I have asked about any herpes blood test has said it's inaccurate.  However, some quick searches I have done on this forum have said the IGG test is the way to go.  

I did speak to an ex-girlfriend from when I was in college.  She reminded me that she was diagnosed with HPV but not HSV.  I did forget about that but from what I've read about HPV, my symptoms dont match up with it.   In all reality, I probably have HPV because we were together for several years and had unprotected sex on many occasions.  

Again, thanks a lot for you help.  I've been reading this forum for various other things and I think it's great this is out here for people like me.

[H. Hunter Handsfield, M.D.]

The additional information doesn't change my opinion or advice.

Re "You said that herpes does not show up in less than 2 days but in the sentence before you mentioned that the red bumps could have been from herpes acquired the night before?"  See my follow-up comment.  Perhaps you were writing this statement before I posted mine.

[H. Hunter Handsfield, M.D.]

The additional information doesn't change my opinion or advice.  Either your east coast doctors don't know what they are talking about in regard to HSV blood tests, or you misunderstood them.  You can trust them as non-STD experts, or you can trust me.  Your choice.  

Re "You said that herpes does not show up in less than 2 days but in the sentence before you mentioned that the red bumps could have been from herpes acquired the night before?"  See my follow-up comment.  Perhaps you were writing this statement before I posted mine.

The bottom line is that I doubt you have genital herpes.  But get tested and you'll know for sure.

[freakinout369]

My apologies, I did post the comment before I read your correct response.  I am in the process of looking for a STD clinc that will perform the HSV blood test.  Thanks again for your help and advice, it's much appreciated.