HSV Confusion

[duke144]

I'm a white male, age 30.  Symptoms began in mid-June. Recent episode below:

12/11 Notice a few bumps/blisters on the far left side at the intersection of scrotum/penis shaft/abdomen
12/15 Notice 2 similar bumps/blisters on the right side of the scrotum up near the shaft -  still red to this day.
12/19 Skin appears red & somewhat inflamed on the top left side of the shaft at the very base.  Next morning bumps appear. Gone in few days.
12/27 Notice 2  bumps again at the base
12/29 For the 1st time ever I notice redness on the top of the shaft covering about an inch just below the head area (not the circumcised area)  Bumps/Blisters seem to form which burst.

Ive read that HSV-2 in men usually occurs on the shaft & that HSV "does not hide" hair bearing areas. All my abrasions occurred well inside the pubic hair line (up until 12/29). Ive read here that herpes is always on one side or the other.  My bumps have ocured on both sides, sometimes at the same time. Read here that symptoms recur within 1 inch of the orig spot. My case they are jumping all over. Is it possible that I am over inspecting & have caused irritation or caused them to spread by masturbation? Ive read that HSV will recur then not show up for at least month. I also have NO prodromes  & abrasions are completely painless even with direct pressure applied. Ive read the Docs dismiss HSV for any one of these reasons, let alone the combination of them all. This all seems highly uncharacteristic of HSV

I suffer from anxiety and am going thru a divorce for 9 mos & anxiety/depression at an all-time high cause of Holidays. I began dating a girl in late March & we've been in a monogamous relationship since early May.  She has said before that she had been tested for STD's at her gyno visits & was clean but I know they usually don't test for HSV unless specifically requested.  My wife of 8 yrs never had anything show up relating to HSV-2

[Edward W Hook, MD]

Thanks for the detailed description.  From the sounds of things what you have is not herpes.  As you point out, HSV does not move from side to side and the location is rather atypical, HSV most often appearing further out on the shaft of the penis, near the tip.  What you describe sounds like a possible fungal *yeast) infection which tend to occur in skin folds or some other dermatological process.  the most direct way to address what is going on is to have a dermatologist or other trained health professional take a look.

Your relationship situation does not sound like HSV is likely either.  As you point out, although your current GF has been checked for STDs, many (perhaps even most) health care providers do not include screening tests for herpes (the blood tests in such evaluations).  

Once more, to repeat the bottom line - your rash really sounds nothing like typical herpes and while the presentation of infection may be atypical, much of what you say really does not match up.  I would not worry about herpes while you wait for your appointment with the dermatologist.  EWH

[Edward W Hook, MD]

I'm not sure I realize what you mean by your questions.  There were a number of statements/generalizations about herpes in the response you mention, not question. If you are looking for validation that those statements are correct than consider this response to be that, with the exception of your statement that "Typically there would be warning sign like tingling or itching."  These sensations, called prodromes, occur in 20-25% of persons with recurrent genital herpes.  

EWH

[duke144]

Thanks for replying Doc,

I have taken your advice and am happy with your bottom line thoughts pertaining to my case.  I was however hoping you could address the questions I had in my 2nd post.  As I mentioned I have been a frequent visitor to this site (and many others) over the past 6 months and have read countless posts.  As you well know, there is a lot of misinformation by unqualified sources floating around the internet about HSV-2.  I think that by dispelling some of the myths and misconceptions about the behaviors of HSV-2 by providing some very basic answers and clarification, you would be doing us all (visitors to MedHelp)  a great service.  

Both you and Dr HHH are respected experts in this field and I know that everyone here would appreciate it.  If you are short on time because of the holiday, please take your time and answer at your convenience.  If you are too busy to provide any further clarification, I'm sure we will all understand.  Thanks again for your initial response, it has put my mind at ease.  Happy New Year to you and Dr. HHH and all the MedHelp readers!

[Edward W Hook, MD]

Your repeatring my answers back to me does not change my opinion.  As for your questions-

As I said, this could be a fungal infection.  Lamisisl might help and might not.  Since you have psoriasis, you have a dermatologist.  Rather than overthinking things, which is what I think you are doing, why not ask the person most qualified to examine you.  EWH

[duke144]

Thanks Doc, but just to reiterate -
This has been going on since mid-June and these bumps/blisters recur near the same 3 spots; left side at base/scrotum pelvic intersection, right side scrotum up near very base of shaft, and top left side of shaft at the very base and has recurred about 4 times since then in the same drawn out fashion.  Then this new random area on the shaft toward the front.  

To clarify your reasons against HSV-2:
1) Typically don't form so far inside the hair line
2) Typically don't form on opposite sides of the body's midline
3) Typically don't form in 3 or 4 different areas or in succession with so little time between outbreaks
5) HSV typically manifests by red skin, blisters form, break, crust, scab, disappear and don't reappear for at least a month (and usually within an inch of the same spot)
6) Typically these things would hurt pretty bad if HSV and cause pain, itching, and/or discomfort
7) Typically there would be warning sign like tingling or itching.
8) Typically a recurrence wouldn't randomly appear in an area previously not affected (the 12/29 shaft area) because HSV typically can be spread to yourself in another area by masturbation or towels etc.

If this is in fact a fungal or yeas infection, do my symptoms of it happening in these same 3 areas typical of such an infection?  Would bumps/blisters occur and burst?  If so, would Lamisil powder in my underwear help the situation?  

I do have very mild psoriasis which shows up in small ovals on my body and a couple times on the genitals. I always thought it was some STD til a few years ago after I realized if the duration of months was too long to be STD related. So I think in my mind its easy to jump to conclusions.

As you can see I've done some homework before posting about what the Docs have said on this forum.  I also know to take you at your word and don't over-think and obsess or over-inspect the area, which can only hurt the situation and healing process.  Thanks in advance for your answers to these questions.  It is greatly appreciated!