Herpes - Itch on buttock and scabbing

I have taken a look through quite a few of the questions on the herpes forum, and was all set not to worry further until I found a question from the dermatology forum where the symptom looks quite a bit like what I experienced recently for the first time, and the doctor there advised that it sounded like herpes (that poster, "kiwi23" from 3/4/2003 had the problem recur over 20 years).

I am a male heterosexual in my early 30's. I had sex on August 19, 2006 with a woman I met only that evening. We had vaginal intercourse, where I wore a condom. I then removed the condom and received oral sex for seveal minutes without climax. We had vaginal intercourse again, where I wore a condom. At times, I think the condom during intercourse moved up about an inch from the base of my shaft. I did not see any sores on her lips or mouth, or vagina, but I did not ask about STD's. We met again 2 days later and kissed, but there was no genital contact.

At some point in the following week, I noted what looked like 2 mosquito bites together that were intensely itchy on my right buttock. I did scratch the spots, often through my underwear. This stage was maybe from August 24 - August 29. I did not check closely visually over the next several days, but it felt like the bumps were not as pronounced but the affected area had grown. It now felt more like there was something of a scabby-edged strip about 1/2 inch to an inch. I never really looked to see if there were fluid filled sores or anything, but as I think back it seems like the area was moist. Over the last several days, the itch was less intense, but still there and also some tenderness. On Sept. 4, the itch was gone, but I looked at the area and saw it was blackish and looked like scabbing, with some skin in areas. At that point, I worried about herpes. I saw my primary care doctor on Sept. 5 or 6. After visually examining the area, he said he could not rule out herpes, because of the scabbing, but that it could have been a staph infection and it was too healed to know. I asked him about a blood test and he said there wasn't one that would be helpful (I see from this forum that isn't the case). He told me to put it out of my mind, that he thought the likelihood I had herpes was low and to make an immediate appointment if I saw the same bumps and he would take culture from the area.

This recent encounter was the first sexual contact I have had since June of 2003. I had protected sex a few times for the years before that, and was in a relationship in 1998-1999 during which I had a lot of unprotected sex with my partner. Similar pattern for the 5 or six years previous. I can see from your reponses to other posters that I am low risk.

1) Would you advise I get tested? If yes, when? I am planning to wait 2 months, but am hoping you tell me it doesn't sound like herpes and I don't need to.

2) If you think it sounds like herpes, what do you think the likelihood is that I caught it from the encounter I described?

[H. Hunter Handsfield, M.D.]

The first symptoms of genital herpes, i.e. the first outbreak, almost always involves the genitals directly, not a peri-genital area like the buttocks.  Most recurrences also directly involve the genitals, but repeat outbreaks can involve anyplace in the "boxer shorts" area, including buttocks, upper thighs, etc.

From your description, the lesions could be herpes, or any of several other things.  There simply is no way to tell by verbal description.  But if you ahve herpes, almost certainly is a chronic infection, not one you caught during the sexual encounter you describe.  Further, because the vaginal sex was condom-protected, your risk of herpes was low from that exposure.

Personally, I would not recommend further evaluation unless/until the lesions recur.  Repeat herpes outbreaks generally involve more or less exactly the same spot; similar lesions several inches away, for example, don't count.  But if you develop another outbreak in the same spot, see a provider immediately (within 1-2 days) for examination of the fresh lesions, possibly with a viral culture or PCR test.

If you remain concerned and want to follow up right now, you could have a type-specific blood test.  It takes several weeks to become positive, but since your infection (if it is herpes) must be longstanding, you don't need to wait 2 months.

Thus, the specific answers:  1) Testing or not at this time is not a straightforward issue; see above.  2) Zero or close to it.

Good luck--  HHH, MD

[HHH,MD]

I should have added that your description is actually pretty good for a mild case of localized herpes zoster (shingles).  That's probably more likely than infection with herpes simplex virus (HSV).

HHH, MD