Help ease my mind...

[mikens]

Hello Dr,
I previously posted in the community but with no reply. Let me first tell my history.   Male, late 20's, 6 sexual partners, and never have had unprotected vaginal sex.  My concern is with a rash appearing on my scrotum approx. 30 days after last sexual encounter. lasted 4 days, with maybe slightly red smooth skin after for a day or so. It was located just below the skin fold of my penis and scrotum.  and only came to my attention when I took a shower and it stung for second, which is what scared me. it was around the size of a dime and a tiny shiny spot located within it (probably what caused it to sting when water hit) I noticed it on a Tuesday night and went to the doctor Thursday morning. I was terrified of it being herpes. The Physician's Assistant looked at it did not think it was herpes at all, and said it looked as if it were some dry irritated skin beginning to heal up and told me not to worry until the test come back. She swabbed it and I also got the blood work done for all STD including hsv 1 and 2. Results due back soon.

Let me add that on that day I was in my swim trunks all day playing basketball, swimming in the community pool for an hour, running for an hour, and rode my ten speed for over an hour, all while in my wet trunks. I did not wash off after I got out, leaving all the chemicals on me (dumb) so this might be a reason. I've never had an outbreak before, yet I have had the scare once before, but got the test done (negative) and realized my rash symptoms started only hours after protected sex and no std can begin hours after contact. Still freaked me out for months though.

Is it possible for this to be a initial outbreak? nothing looked like the classic case of herpes.

Can a dirty pool and it's chemicals have helped start a rash like this?

Friction or trauma from riding bike in wet trunks?

I know all my ex partners still, except for the last one, which was a one night stand with a younger girl (21) who also had condoms with her.

[H. Hunter Handsfield, M.D.]

Welcome to the STD forum.

No STD causes rash of the scrotum as a primary symptoms, and rarely if all any scrotal skin problems at all.  You symptoms don't even hint at herpes, which never causes diffuse rash covering substantial areas of skin.  Herpes lesions are always localized blisters, sores, or scabs -- and those lesions rarely occur in a patch more than an inch in diameter.  And initial genital herpes doesn't last as long as you describe.  And clearly your PA doesn't suspect herpes -- and since you haven't ever had unprotected vaginal sex (and presumably not anal sex either), genital herpes is extremely unlikely on that ground as well.

For these reasons, you can expect both the swab test and the HSV-2 blood test to be negative.  HSV-1 is a different matter, since half of all adults have positive tests, mostly going back to a childhood oral infection (with or without symptoms of cold sores etc).  In any case, even if your HSV-2 blood test were positive, I would conclude you have asymptomatic HSV-2 plus another cause for the rash of your scrotum.  (If the swab test is positive, it will prove me wrong -- but it will be negative.)

Non-STD causes scrotum rash far more common than herpes or any STD does.  There are many causes; indeed, any of the hundreds of causes of skin rash anywhere on the body sometimes can affect the genital area.  Jock itch is always a good bet, or it might be some other sort of superficial infection or irritation.  But I can't comment on the specific possibilities you raise; that's a question for your PA.  You could ask her about trying an antifungal cream for possible jock itch. If she can't figure it out or if a trial of treatment doesn't help, ask for referral to a dermatologist.  But in the meantime, try to get your mind of herpes.

Good luck--  HHH, MD

[mikens]

Thanks Doctor,
I'm not all that concerned about oral herpes. Many people have it, so it doesn't bother me. just the genital herpes (scare) scared me. also, I noted that the rash was about a dime size (1/2 inch or so). Your reply said "diffuse rash covering substantial areas of skin." It was localized, itchy, though never any blisters. Although, when the small shinny spot located within the rash did heal it kind of skinned over and never resulted in a traditional scab that you see from regular open wounds. On day 3 and 4 I could put lotion on it which helped it go away.

Does this still not have a hint of genital hsv?  I won't reply any more after this. Thanks.

[mikens]

Hey Doctor,
Just thought I'd let you know. I just got all my lab work back, NEGATIVE  for everything!

The culture was non reactive
hsv 1 igg = .08
hsv 2 igg = .12
negative for every other std/hiv too.

Even though the igg test were only 30 days since my last protected exposure (which is the one I worried about) still eases my mind that I do not have herpes because it was accompanied by the negative culture. I'm a bit surprised about hsv 1 though, thought for sure I would have had that.

Wow, searching the internet accompanied by anticipation and worry made me a nervous wreck.

**Not every symptom has to be an std I have come to find out. And, I guess condoms do work.  

Thank you doctor. Your advise on this forum helps lots of people with their anxiety.

[H. Hunter Handsfield, M.D.]

Congratulations on the negative blood tests.  I agree you can put herpes aside.  The negative HSV-1 result is not all that surprising.  Many people who believe they had oral herpes (cold sores, etc) in fact had other causes of their symptoms.  Also, the HSV-1 blood tests are more often false negative than for HSV-2, so you might still have had oral herpes.