Mysterious Red Sore - Follow-Up Question

[hindsight]

Hi Doc,

I posted a question on 12/9 regarding a painless red sore that developed on my penis. It's turned out to be somewhat mysterious - Long story short:
During treatment of my foreskin with podofilox for genital warts, a painless red sore developed on the tip of my penis directly above the area of foreskin where the podofilox was applied - The sore started in my second treatment weak and began as an area of red discoloroation before developing into a painless, slightly raised red sore.

I initially linked it to the podofilox, figuring the affected area became irritated after the treated skin folded onto it for significant periods of time.

The sore lasted for about two weeks total - maybe a little bit more if you count how it resolved and disappeared gradually.

I consulted a dermatologist about it to be safe and he sent me for a herpes blood test. I also posted my question to you - and described other symptoms (rash on feet, white spots on tongue, itchy rash on body) and activities (history of unprotected oral sex). You suggested syphilis as the most likely std, if in fact I had one.

I got tested for herpes and syphilis - and HIV, Chlamydia and Gonorrhea. I came back negative for everything except HSV1. I get occasional sores on the corners of my mouth - though I'm not sure if they're herpes, and just this week I developed a different sore on my lip, that kind of went white in the middle, then subsided and the skin is now kind of healing itself. I'd guess that's a herpes cold sore, but obviously I'm not a doctor. Other than that I've never had herpes symptoms anywhere.

I got a new spurt of genital warts a week ago, in pretty much the same area (towards the top of the foreskin - centre and to the right) and again I treated with podofilox. Pretty much a similar painless red sore has begun to develop on the same spot on my penis. Right now it's pretty small (it started yesterday). Again, it's directly where the treated foreskin would fold onto. The treated foreskin is also a little weepy or raw after being treated.

In my mind I was relieved as it seemed to pretty much connect the sore to the podofilox - it had been left unexplained, but when I went back to my dermatologist today (he requested I see him if the sore returned) he wasn't all that interested in the podofilox and proscrived Acyclovir. He told me to come back and see him in 9 days.

My questions to you are:
Bearing in mind I tested positive for HSV1 and negative for HSV2, and the second sore has recurred within 3 weeks (probably 2 1/2 to be exact)between of resolution of the previous one, how likely is it to be genital HSV1?
How likely is it that the podofilox is responsible for these?
I tried to point out the sore on my lip to the Doc as I figured this was relevant to the herpes discussion but he was uninterested in it. He's not the best communicator in the world. Should I consider switching dermatologists?

Thanks for all the good work.

[hindsight]

Thanks for your response, Doc.

Two quick questions:

It seems the chances of having HSV1 both orally and genitally is quite low. Is this an absolute - i.e. it's medically impossible to have both - or just generally true and every once in a while someone can have both?

Assuming my HSV1 is oral, how much should I take this into consideration when starting a new relationship and the possibility of passing it on to her genitally?

[H. Hunter Handsfield, M.D.]

Sorry, this is too complex a situation for me (or any assessment except by a personal provider) to very helpful.  I doubt the genital lesion is herpes; the description doesn't sound at all like herpes and HSV-1 doesn't often cause frequently recurring genital herpes.  Irritation from podofilox sounds reasonable, but that's only a guess.  The oral lesion might be herpes, but I have no way of telling.  I cannot comment on the care provided by your dermatologist, but if you're not happy with his communication style or effectiveness, it seems reasonable for you to find another provider.

Good luck--  HHH, MD