Possible Genital Herpes or other condition?

[longview_drive]

Hi,

I have done a lot of online research, but nothing satisfactorily answered the two episodes I've recently had.  About six months ago (December) I noticed I had about a dozen or so small red bumps all in my pubic hair area.  They were not clustered, they did not hurt (unless I pressed really hard on them), and I didn't have any other physical symptoms such as fever, aching, or swollen areas.  I also did not notice any in the my labia minora/majora.  They persisted for exactly two weeks, slowly disappearing by drying up and fading away.  Up until then my last sexual contact was a month prior, which was unprotected but was restricted to oral sex.  I thought it might have been foliculitis.  

I just had a sexual episode this week with a partner I am not entirely sure of history-wise, and today (the day after) I noticed a very small bump on the inside of the my labia minora, very near the lip towards the clitoris, and some skin shedding around the lips.  It's a very fine shedding, and in very small spots, so it's not like a major scab falling off.  Again I am not feeling any strange symptoms of itching, swelling, or pain.  I am sensitive in the area in general because of the vigorous physical contact.  I am also not sure if the tiny bump on my labia developed today or had been there for a few days.  It is raised and but appears flesh colored and doesn't appear sensitive to touch.  

I am fearing the worst which is an STD, possibly Herpes 2.  While I know the symptoms are not typical, I also understand that it's rare for a disease like Herpes to behave in a predictable manner.  I am just very worried about what the possibilities might be, and the best way to possible home-medicate this tiny bump on my labia if it is not STD-related.

Many thanks,

[Edward W Hook, MD]

Trying to guide you towards alternate diagnoses over the internet would be improper of me and not in your best interest.  The persistence effectively rules out that this is HSV.  I would advise you seek the input of a dermatologist.  EWH

[longview_drive]

Hello,

Many thanks for your comments, I'm mostly relieved.  The lesion on my labia still persists.  It has not changed in size or color and this would mark the third week of its existence since I discovered it.  Is there any other illness that might be associated with this?  There are still no physical ailments associated with it.

Thanks again,

[Edward W Hook, MD]

Several comments which I hope will be helpful for you.  I doubt that either of the problems you describe is herpes and, if one is, I can assure you that the other is not.  While you are correct that the presentations of herpes can be highly variable, the infection does tend to repeat its presentations in any one person.  Thus for the infection to present once in the pubic hair and a second time on your labia is not consistent with herpes.  Several more generalizations which also add to my suspicion that this is not herpes.  

Typically when a person has a first episode of herpes, the rash of herpes is  accompanied by a flu-like illness with some combination of swollen glands, muscle aches fever and discomfort.  That you did not have these makes the rash you had in December unlikely to be herpes.  Another factor which makes it unlikely to be herpes is the location-herpes in the pubic region is uncommon.  Finally, herpes typically appears 4-10 days following exposure, not after a month. when all of these factors are considered, this rash is quite unlikely to have been herpes. In my opinion, you were probably correct when you thought is was likely to be folliculitis.

Now let's consider your current symptoms.  While the timing of exposure is within the range of when herpes might be expected to occur, nothing else about the description you provide suggests herpes.  A solitary lesion is more likely to be a recurrence than an initial episode and if this is the first time you have had a lesion at that location, that too makes herpes less likely.  If the lesion is still there, you could get a culture or PCR test done on a swab from the lesion to rule out herpes (a  blood test would not be helpful for diagnosing a lesion that had appeared just in the past few days).  I predict it will be negative.  There is no downside to having the current "bump evaluated by a health care provider.  i would suggest you do this sooner than later.

Hope this helps.  EWH