Herpes! (Or not)

[rocksteady561]

I will make this short and sweet.  Scratched an area  that itched at work; looked a few hours later and had a Lesion on my buttocks almost at the waistline ( where it itched) roughy 5 mm by 5mm.  Never really raised, looked like a sore with no scab, kind of wet looking day 2, but day one maybe a slight scab at best.  Dont know a better description than that. 1 hair in the middle right quadrant.  3 days later appeared to be a white spot  (1.5mm x 1.0mm) lower in right quadrant, maybe 1 mm below the hair.  slightly raised, maybe to normal skin level.  What  has me worried is the white spot. Could the spot have been a herpes blister) or normal healing process from a deeper part of the sore since i did scratch.  I should also mention no sex in a year, blood test for igg elisa 6 months ago negative for 1 and 2.

Questions:

1.  Opinion on the white area
2. Can herpes ever have hair growing out of it, or will the virus cause the hair to fall out from killing skin cells
3.  How good are blood tests for both types
4. Can you have herpes within another normal lesion, say folliculitus, since there was a hair (another white spot question)

I wish I could trust the blood test, but the Internet has me scared about all these people that have negative hsv1 blood but culture positive

Sorry not as short and sweet as I anticipated!

[rocksteady561]

I should also add only 1 white pimple/blister lesion

[Edward W Hook, MD]

Any recurring lesion shold make people consider HSV but folliculitis allow tends to recur, as do many other dermatological conditions.  All things considered this is still most unlikely to be HSV.

Stay off the internet.  In situations such as yours it is not your friend.  EWH

[rocksteady561]

Dr Hook- I promise this will be my last comment, but the Internet has scared the H out of me (probably like most people on this forum).  I want to thank you I'm advance for the compassion you have shown me and other patients on this board.  

Last night I had what was a small blister / whitehead on the lower part if the lesion I described above.  Other than that all the swelling had gone done from when I wrote on the 5th.  I was able to pop or scratch off whatever the bump/blister/whitehead was. Does this give more evidence to herpes or against herpes?  Also, and I think you have said this to me and many others, but I just wanted to confirm, just because something recurs in the SAME SPOT  like my lesion does not make it herpes.  The lesion simply may not have 100% healed, etc?

[Edward W Hook, MD]

Great, glad to help.  EWH

[rocksteady561]

Dr. Hook- took your advice and went to a MD.  He thought folloculitus which I suppose is a reasonable diagnosis.  Thanks for all the help

[Edward W Hook, MD]

I cannot make a diagnosis over the internet in a person I cannot examine.  There are many skin conditions which have a tenedency to recur, eczema certainly being among them  My suggestion would be for you to go see your regualr health care provider or, if you do not have one, to see a dermatologist.  EWH

[rocksteady561]

Dr. Hook,

Sorry for the late follow up question.  

It has been a month or so since all of this began.  Today, the area is not an open lesion, but once again red, raised and itchy (how it all started initially) There is still a hair in the upper right quadrant. I know we both agree not herpes, but if not then what?  Can exzema do this?  Thinking more on the area, it is right where a majority of the tag in my boxers would hit.  Maybe just aggravation?  Just comfused why something would go away and then come back in the exact same spot raised, irritated and itchy .  I know this is no substitute for a clinical exam, but any suggestions would be appreciated.  

[Edward W Hook, MD]

1.  While the "boxer shorts" distribution is fair game, 85% of HSV lesions in men occur on the distal half of the penis and the vast majority occur on the genitals themselves.

2.  You seem to have misread my statement.  I siad "you have not had an exposure at a time that makes infection likely".  Nearly all initial episodes of HSV occur within two weeks of exposure.  You said " no sex in a year".

3.  Correct.

4.  No data.  It would be uncommon however. EWH

[rocksteady561]

Dr Hook- reading back through, sorry for all the typos; I have been replying from a phone

[rocksteady561]

In Classic MedHelp fashion just a few follow-ups.  I know te overall message, don't worry, not herpes but:

1.  You mention te location is unusual.  I thought anywhere in the "boxer" region was fair game.  Are you referring to my specific location of the waistline / beginning of buttocks area, or in general genitals are more common?  What % do you clinically see that is boxer area and not genitals, or am I thinkin about boxer area completely wrong, and it is more inner thigh, etc

2.  What do you mean I have not had an exposure at a time? I have not had any I know of, but now I know you can even get it from oral sex even if someone does not have an active coldsore!  

3.  Looking at exudate- it may have been that.  I am assuming that is normal in all healing lesions, herpes or not.

4.  I know blood tests are not perfect, in you opinion, in a normalized population how often will you have false negatives for type 1 an type 2 ( I know type one is not as good, and actually type 2 tests are pretty good)

[Edward W Hook, MD]

Welcome to our Forum.  As I prepare to answer your question it is important for me to point out that we make assessments of the probability of infection on the basis of integrated assessment of exposure history, description of symptoms, test results and other information provided.   Putting it all together, the chance that the area you have noticed is herpes is close to zero and something I would advise you not to worry about.  The location is an unusual location for HSV, you have not had an exposure at a time that makes infection likely, your negative blood test makes infection unlikely and the description of the lesion is atypical.  For these reasons, I would not worry about herpes and would not seek further testing.  To do so would represent paranoid thinking.

As for your specific questions:
1.  Opinion on the white area
I have never seen a HSV lesion appear as a white spot.  Healing lesions might have white exudate as part of the healing process but what you describe does not sound like that.

2. Can herpes ever have hair growing out of it, or will the virus cause the hair to fall out from killing skin cells
Not typically.

3.  How good are blood tests for both types
They are not perfect but they are good.  Interpretation is situation specific. False positive tests are more of a problem than false negatives.

4. Can you have herpes within another normal lesion, say folliculitus, since there was a hair (another white spot question)
Again, not typically.

I hope this helps. As I said, I would not worry about this. EWH