STDs Expert Forum
Herpes Anxiety
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The STD Forum is intended only for questions and support pertaining to sexually transmitted diseases other than HIV/AIDS, including chlamydia, gonorrhea, syphilis, human papillomavirus, genital warts, trichomonas, other vaginal infections, nongonoccal urethritis (NGU), cervicitis, molluscum contagiosum, chancroid, and pelvic inflammatory disease (PID). All questions will be answered by H. Hunter Handsfield, M.D. or Edward W Hook, MD.

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Herpes Anxiety

Jan 20: Got a massage.  Masseuse started to play with my scrotum before I told her to stop and only massage my legs.  Her hand did touch my scrotum after that in the course of doing my legs.
Feb 5: Got a slight cough, went to bed, woke up with a sore throat, swollen neck glands, and muscle fatigue
Feb 6: 10 hour flight, followed by a shower, after which I noticed a painful spot when touching my scrotum. I inspected it (on the underside in the middle and hard to see) and it was a pinkish spot maybe 3-4mm across.  Stretched the skin and it appeared to be a raised spot, didn't look too much like a blister at the time  I went to sleep for 2 hours, when I woke up the spot had a moist surface and was still slightly raised and pink.
Feb 7: Spot was scabbed over and not painful.  Went to sexual health clinic and was told that it looked like a popped sebaceous gland or blocked pore or something (he did not think it was an STI).
Feb 8: Spot gone
Feb 10: All skin on scrotum peeled off, like a sunburn, presumably because I washed it more often and used more soap than normal.
Feb 12: Still mildly ill and anxious, had a rapid HSV-2 test at a different clinic (back in US).  It came back negative, although I suppose this may be too soon to have been tested.
Prior to this, I have had two similar encounters at massage parlors (never actually received a handjob, always stopped masseuse after realized it was not legitimate).
I have been with the same person for 5+ years.  We have not been very sexually active the last few years, but we have mutually masturbated in the last 2 months and had oral sex once in the last 4. I haven't had intercourse in 3 years. I'm not terribly concerned about myself, but I do not want to pass it on, and I don't want my marginal indiscretions to ruin an otherwise good relationship.  The more I read, the more concerned I become; much of the discussion here seems to indicate that scabbing and clear discharge are a strong indication of HSV.  Thanks.
239123_tn?1267651214
Welcome to the forum.

Whatever is going on with the skin of your scrotum, it isn't herpes or any other STD from the massage.  HSV is not transmitted by hand-genital contact, especially the sort of brief contact that apparently occurred with your scrotum.  Further, initial herpes rarely involves the scrotum and does not cause the sort of skin lesion you describe, and your sexual health clinic provider obviously agrees with me on that.  (To say that herpes can be associated with "scabbing and clear discharge" ignores the fac that ANY lesion involving broken skin will scab and often produces "clear discharge".)

While we don't speculate much about non-STD causes of symptoms, I wonder whether you are taking any medications -- and especially if you started treatment with any new drugs in the 1-2 weeks before the skin problem started on your scrotum.  Your description is suggestive of a condition called fixed drug eruption, i.e. a localized allergic reaction that can occur with a number of different medications.

Anyway, all the evidence is strongly against herpes or any other STD. You don't need testing for STDs and I recommend you continue unprotected sex with your wife without any worry at all.  

Best wishes--  HHH, MD
7 Comments
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Avatar_m_tn
I guess I should add that she wiped me down with a hot towel after the massage; I don't know if that's a factor in anything.
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239123_tn?1267651214
No, I'm sure it's not.
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Avatar_m_tn
Thank you for the advice; it's very difficult to spend any amount of time on the internet without convincing yourself you are suffering from something. I am not currently on medication, but I was taking malarone for malaria prevention for about a week from Jan 22 through Jan 29.  I had forgotten all about that.
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239123_tn?1267651214
Indeed the internet can be dangerous for anxious persons with unexplained symptoms.  Perhaps you're familiar with Nate Silver, who has become rather famous for his political predictions (http://fivethirtyeight.blogs.nytimes.com).  He has written a book about statistical issues in everyday life (The Signal and the Noise, Penguin Press, 2012).  Here is a quote from it:

"...what might happen if you put a hypochondriac in a dark room with an Internet connection.  The more time that you give him, the more information he has at his disposal, the more ridiculous the self-diagnosis he'll come up with; before long he'll be mistaking a common cold for the bubonic plague"

Anxious people tend to be drawn to information that reinforces the anxiety, and to miss the reassuring bits, even if they're more common.

I think I may have nailed the cause for you; a fixed drug eruption from Malarone (a combination of two drugs, proguanil and atovaquone) seems a fair bet.  On a quick medical literature search I don't find them mentioned as causes of FDE.  However, the well known causes include other drugs that are chemically similar.  FDEs typically begin 10-14 days after starting the offending drug, so the timing seems right.  If you google FDE (spell it out), you can find lots of pictures.  The basic appearance and natural course are pretty much like a burn:  painful redness, blistering, then sloughing of the superficial skin to leave a raw, red spot that then heals, often with scab formation.  And the genitals are among the most common sites for FDE.
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Avatar_m_tn
Thanks for the help Doctor, I feel quite a bit better.
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Avatar_m_tn
My symptoms didn't look quite like the photos of FDE, but the idea that hand-to-genital contact cannot spread HSV is pretty convincing.  I appreciate what you do, and I appreciate the info.
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University of Washington
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