Need to put incident behind me

Hi Doctor,

I need to put this situation behind me.

On 5/23/2009, I had protected sex, and shortly after developed some discomfort in my genital area.  Around 6/16, I developed a rash around my anus, which I still have. I a now on  a third prescription from the doctor and the rash is still there.     On 6/28/2009, I had  a Herpeselect test and STD tests which  came back negative, (positive fo HSV1)  and I had another one done on July 30, 2009, which also came back with the same results.   About a week ago, I developed a rash between my inner thihgs and scrotum  on both sides.  It's red and it looks like pimples.

So here are my questions:

1.  I hear conflicting opinions with respect to how long it takes for the HSV2 virus to show up, It has now been a little over 9 weeks since possible exposure.   Can I feel confident that I don't have HSV2?  Why do some say it takes longer to show up?

2.  What could this new rash / pimples that have just appeared around my inner thighs / scrotum be?

Thank you for your assitance.

[Edward W Hook, MD]

Before I address your questions, let me comment that there is little reason for you to be concerned about herpes.  Your sexual expsoure was condom protected and condoms are good protection against herpes.  In addition, your symptoms are not suggestive of herpes either.  

Now straight to your questions:
1.  How long it takes HSV to "show up" depends in part on what manifestation one is looking for.  The rash of herpes typically appears 4-10 days following sexual exposure and then last up to 3 weeks for first episodes and 3-10 days for recurrences.  On the other hand, blood tests may take longer to become positive because it may take a longer period of time for the body to produce the antibodies that are detected by the blood tests.  If a blood test is negative at 4 months  a person can be confident that they did not get herpes.  In your case, you have little to worry about.  The symptoms you describe are not suggestive of herpes and in that setting (the absence of suggestive symptoms) a negative blood test at 8 weeks or more is a strong indication that you did not get herpes.

2.  There are many different causes of genital and scrotal rashes.  When I read your description the first thing that came to mind was a fungal infection or folliculitis but my advice is to have a health care professional take a look.  A direct examination is far better than my evaluation over the internet.

Hope this helps.  EWH