It all started with a Pimple

[Totaler]

Hello

I have wierd things going on on my penis (to say the least). About 2 weeks ago I developed a single pimple on my shaft which I dismissed as folliculitis because it had a tiny hair in the middle of the bump. Then as that lesion was disapearing in about 4-5 days I noticed something odd here is the detail of what happened after that:

1. about an inch and a half above that pimple I noticed what looked like a healing sore (or maybe it was just a rubbed spot). I freaked out about this and went to the STD clinc and I was told that it was not herpes. I will call this lesion no.2

2. A 3 days after my STD clinic visit I saw yet another irritated area right next to the lesion no 2. This area was sort of rubbed off skin maybe a bruise looking and there was a small scab on it. Now the interesting thing is I never saw a blister nor did the STD clinician who looked at it before the scab developed. I will call this lesion no.3

3. after both Lesions No.2 and 3 were disaprearing after about 5 days after the apearance of lesion No.3. and after lesion no.1 had completly disapeared I developed YET another pimple on my shaft in the same area. This one also had hair in it and I just ignored it. Lesion No.4

4. I saw a similar fresh lesion yet again yesterday meaning 3 days after lesion no.4 popped up and after all the other ones had completly disapeared. This lesion was also on the shaft and looked exactly like lesion no.2 and it looked like a small oval area of rubbed of skin again I never noticed a blister and I was looking at the area closely almost every few hours.

I feel like I have herpes but these lesions are certainly not typical and except for lesion no.2 none of them had scabs, non of the lesion hurt to the touch at all, never noticed blisters, and they apeared one after the other and not at the same time at all.

Relevant history: Six months ago I tested negative on HSV2 with Herpeselect.

[H. Hunter Handsfield, M.D.]

Herpes doesn't generally behave the way you describe.  Specifically, herpes doesn't cause 1-2 lesions at a time followed by new single lesions at 2-3 day intervals.  An herpes outbreak, or a recurrence, would appear all at once (over a day or two).  An initial outbreak might have new lesions appear over a few days, but nothing like you describe.  With either initial or recurrence, the lesions generally clear up over 1-2 weeks; and recurrent outbreaks never occur more often than once a month or so, with no symptoms at all between those symptoms.  I think you will agree this doesn't describe your situation.  When you add the two other salient facts -- that an STD provider didn't think the problem looked like herpes and your zero to low risk for new genital herpes -- I think you can put herpes to rest.

What else might it be?  My best guess is that you have become colonized with a virulent bacteria like staph or strep that is causing serial episodes of folliculitis or similar skin infection, like impetigo (which is a superficial strep infection of the skin).  You should see your primary care provider and suggest (if s/he doesn't suggest it him/herself) that your penile skin be cultured for staph/strep.  An antibiotic cream might clear it up; or perhaps s/he will prescribe an antibiotic by mouth.

In the meantime, don't assume that just because your genitals are involved, herpes or another STD must be the cause.  Of the hundreds of things that can cause skin rash or lesions anywhere, most can affect the skin of the penis.

I hope this helps.  Best wishes--  HHH, MD

[H. Hunter Handsfield, M.D.]

If you are colonized with staph or strep, it is all over your skin, certainly from navel to knees, probably with particular concentration in the most warm, moist areas -- anus, genitals, groin, etc.  It could be truly body-wide, i.e. face, arms, nose, etc.  This is why systemic antibiotics sometimes are necessary and not just an antibiotic ointment in the affected area.  There is no particular rhyme or reason why an active infection pops up at one spot or another.  Sometimes it relates to very minor trauma, e.g. scratching an itch.

[Totaler]

Thank you doc. This forum is great and it is impossible for me to get this sort of explanation from any health care provider here. I appreciate all your work. I have a question, could I be spreading the bacterial infection with my hands to other parts of my penile skin? because the way these lesions appeared, it seems to me that ones one of them pop up I touch them a great deal (investigating) and then 4-5 days later another lesion pops up in the general area. and 2-3 days later another etc...

[H. Hunter Handsfield, M.D.]

I saw this comment before I responded above, and took it into account.  This information also supports my belief you do not have genital herpes.

[Totaler]

I forgot to mention. My herpeselect result was done at least 8 months before my last sexual exposure and ever since I have only been with my current girlfriend who is STD free. She is a 22 year old college student and I am a 25 year old man. Before her I have only had 5 total sexual exposures and all of them pretty scatered. So when I did my herpeselect test I had only had sex ones in the past 1 1/2 years so if I caught anything it has to be from that exposure before 8 months before my Herpeselect test.