Next Steps

[jeremyst]

I'm in a monogomous multi-year relationship, and made the mistake, 2 months ago of having protected sex with a sex worker. Over the next weeks I developed a rash in my groin that was painful, red, and itchy that resembled jock itch. I am a heavy male, and sweat in that area. I went to my GP who assured me it wasn't herpes or an STD, and suggested that it was Tinea. I used lotrimin which seemed to help.

Anxiety has worn me down to a nub. My wife is pregnant. In the second month I returned to my GP with slight changes in the rash that he said, "If you don't believe me that it's not herpes - I'll send you to a dermatologist."

I went to the dermatologist -  in week 6 after the exposure. (I additionally used Labsafe at 6 weeks to run an HSV-2 IGG blood test in that week which came back negative). He saw slight redness at the tip of my penis, and the rash in the groin. He prescribed a topical steroid, and the rash has gotten worse since application.

At this point - week 8 since exposure - I returned to the same dermotologist who reassured me again the rash didn't resemble herpes or any std. He prescribed another topical steroid to apply to the tip of the penis (focused around the urethra - strictly redness with intermittent stinging pain).

How worried should I be about herpes or any std - given the tests, the protected nature of the exposure. I DO have a painful rash that has come and gone, but have not seen any vesicles with pus, or scabbing etc. I have had some of the peripheral symptoms (fatigue, back pain, etc.) I am worried about my wife and my baby, and wonder if you can give me a sense of what a reasonable mind frame might be for this exposure, and next steps.

[Edward W Hook, MD]

You are right that HSV can cause only mild abnormalities and can be mistaken for other processes however, the nature of your exposure and the evidence to date is compelling that this is not herpes.  Rather than delay sorting out what is clearly a problem for you, I would urge you to cease worrying about herpes and to work with your doctor to find out what this really is.  It is not herpes.  EWH

[jeremyst]

Thanks for your response - my only follow up question is -- there are so many resources online that stress that herpes can be only mildly symptomatic. The rash that i've been experiencing does have tiny red bumps that seem like ingrown hairs, redness and stinging -- hence my overarching concern that I have an STD. Should I treat this as an STD until my final 3 month confirmation that there are no herpes antibodies? Is it safe for me to have sex with my wife? I understand that you can't give me a definite answer - only looking for your respected opinion naturally. Thanks for your help.

[Edward W Hook, MD]

STD is not a concern for you, and particularly herpes.  Your exposure was protected, he rash you describe in no way sounds like herpes and you have negative tests.  You do not have herpes.  This then leads to the question of what could it be.  My first guess is that it could have been a fungal infection, similar to what your doctor said and tried to treat.  Since that didn't work, the possibilities are either that it was not a fungus or that it was a fungus but the fungus was resistant to the drug used (this does happen once in a while).    That it improved with lotrimin but did not go away entirely could also suggest that perhaps it was not treated long enough.  Perhaps this possibility should be discussed further.

Then your dermatologist worked to treat the process with topical steroids which would be expected to make a fungal infection worse.

My guess is that you have a fungal infection but I would also state EMPHATICALLY that advice over the net does not take the place of working with a trained health care provider such as your dermatologist.  Sometimes these things must be taken care of as a trial and error process and working with your clinician is the right thing to do.

Thus to summarize- first and foremost, you do not have herpes - nothing to worry about from that perspective.  As for what it is, perhaps a fungal infection (see my thoughts above) .  the way to address with it it to work with your doctor to get it sorted out.  EWH

[jeremyst]

By the way - I neglected to clarify that the protected sex was vaginal. thanks. and thanks so much for this much needed site.