Herpes, an ingrown hair... or something else?

[Powerz]

Hello Doctor,

I’ve been a little concerned over a bump that has appeared near the base of my penis.
I didn’t even notice it until it was fairly pronounced. The bump itself was pretty red, and only hurt when pressed.
On the day I discovered the bump, I went to my doctor, who “thought it looked like a possible ingrown hair”, though I requested he swab for herpes anyway.

The day after I discovered it, I decided to press firmly on it, to see if I could get any pus out of it.  Sure enough, white pus came out, though not a lot. It felt a bit better, and I left it alone for the rest of the day.  The next day, the small opening where the pus came out had healed somewhat, however I noticed the bump itself had expanded. I took a pair of tweezers and lifted the “healed” flap of skin, and immediately a flood of white/yellow pus erupted out. I swabbed up the first flow of pus, and then gently pressed on the bump and released a great deal more.  At that point, I thought I would let it be.

This has repeated, although with far less pus, each day for about 5 days, which I find odd.
The bump itself has gradually declined in size, and it does not appear to have “crusted over”, or scabbed, in any way. It’s sort of just healing like regular pimples heal.

In addition to this, for the past 2 days or so, I’ve noticed a very slight irritation at the opening of my penis. It’s present only when I urinate, and even then, only at the start of the flow of urine. Just thought I would state that.

Lastly, I should also state that my girlfriend has HSV-1 (oral), however has never given me oral sex during an outbreak, nor even approached me at all if she felt the “tingling” of an outbreak coming.

Ok, now to the important stuff:
1) Does this sound like herpes?
2) Is it typical for herpes to unleash this type of pus?
3) If a person is going to experience pain while urinating, does this begin at the onset of the “bump”? Mine did not occur until nearly 5 days in.

Thanks very much for your help.

[Edward W Hook, MD]

My closing advice to you is that this really does not sound in any way like herpes.  I'm not suprised that the swab was negative.  Based on what you have said, I would not worry further about herpes, nor would I seek a blood test.    At this time, the results of a negative blood test would be hard to interpret - you wouldn't know if you indeed did not have herpes or if you just tested too soon.  Conversely, a positve test would not tell you whther this lesion was causing the postive blood test, whether you already had herpes but did not know it before testing, or whther the test was falsely postive (a real possiblity in this case).  My sense is that these REALLY has little to suggest that you have herpes.  I would put it aside and not worry further.  I hope you can and will do this.  EWH

[Powerz]

Quick edit - should read, "...concept of false negatives...", not false positives.
Sort of changes the above statement!

[Powerz]

Hi again Doctor,

Results in from swab - negative.
My personal doctor mentioned the concept of false positives, but didn't really seem very sure. I'm not entirely sure she's well read on herpes... (btw, my personal doctor was NOT the doctor who first saw the lesion). As such, she asked if I "wanted" a blood test.

Give that the swab was taken about 36 hours after noticing, what do you think?
I know I stated that this thread was essentially over from my perspective, however she's re-opened this ordeal with little communication to me about false positive statistics etc.

If you choose to answer, thanks again.

[Edward W Hook, MD]

The systemic symptoms which sometimes accompany an first episode of genital herpes tend to occur at the onset of disease and it would be most unusual for them to occur after lesions had been present for 8-9 days. I would look for another reason.  EWH

[Powerz]

Thank you for your post, Doctor.

You've dispelled most of my fears, making the waiting period for the test results a lot easier to handle!

One follow up (and only one, I promise).

I have developed, literally overnight it seems, a few additional annoying symptoms:

1)                  New pain in neck – possible swollen lymph node – would this be common?
2)                  Body aches, muscle weakness
3)                  Headache

Is it uncommon for these “initial” herpes symptoms to appear 8-9 days after the lesion has appeared? In addition, if a swollen node is involved, would it not be more likely to appear in the groin area?

I actually ask this both out of curiosity, and on the off chance that it may help someone else exploring this post later on. Given your initial response, I won't dwell further anyway, but do appreciate any additional response you would have.

Cheers.

[Edward W Hook, MD]

Welcome to the Forum.  The description you have provided is one of the best descriptions of folliculitis (hair bumps) a patient has provided on this site.  Folliculitis occurs when the pores in your skin get plugged.  This allows that normal bacteria that are present on just about every-one's skin to grow and cause what is essentially a pimple.  Some of these just appear as red bumps which may or may not be  tender while others go on to actually form pimples.  In either case, they can be accompanied by swelling of nearby lymph nodes (FYI, swollen lymph nodes are a totally non-specific indicator that your body is reacting to something.  That something causing the swollen node could be folliculitis, an STD, or even athlete's foot).  In some instances, if you look closely you can see a hair coming out of, or nearby the bump- this too is typical of folliculitis).  When folliculitis lesions progress, pus forms within them and can be expressed.  The best way to get this to resolve is as follows:
1. STOP PICKING!  this increases the risk that it will become infected, spread and possibly make you sick.
2.  Wash the involved area daily with a washcloth to keep the pore open
3.  In some instances antibiotics help to clear this up.  If you are concerned, speak with your doctor about this.
4. Be patient

This is not herpes. The lesion you describe sounds nothing like HSV and HSV does not have pus in the lesions.

Your pain on urination is more likely due to the irritation which results from picking at the lesion than anything else.

Hope this helps. No reason to be concerned that this is herpes.  EWH