blister on buttocks - Herpes scare!

[matthewsxy]

Hello Dr. Hook:

I have been trying to read through some of your responses on here and although I find them quite informative, I finally decided I have to ask you about my particular situation.  Thanks for your time.

Four days ago, after getting out of the swimming pool and into the sauna, I noticed an itchy blister on my left lower butt cheek.  I freaked out and "popped" it, and a water-colored liquid, not too much, came out.  It was maybe the size of an eraser head, slightly bigger?

The next day, as the popped blister was "healing" I decided to go to the local STD clinic.  I was tested for all STDs, HIV was negative right away, and the others are not back yet.  The doctor said that what I had did not look like Herpes, but that it was harder to tell since I had popped it.  She swabbed it and is running a non-type-specific HSV test on it, which I might not get the results for for another week or so.  (7-10 BUSINESS days) :(  She also said the test might not work since I popped it.  Is she right?

There is also a small red bump, (not a blister) about an inch above it.  I have also had some minor itchy bumps near my waistline and other places on my butt cheeks in the past month.  I just thought it was bugs or something, as I had been traveling in Europe and East Africa (mainly Kenya)  (note- I did not have sex with anyone in Africa).

Anyway, yesterday at day three, I decided it was causing me so much worry that I should get blood tests done, so I paid for them.  The results came back this afternoon and are a bit scary, even though I know that IgM does have some false positives.  IgM positive, 1.51.  IgG negative for both.

What are the chances that this blister is/was HSV???  When should I get blood tested again?  What else could it be?  Am I doing the right things?  It's now a reddish and maybe whitish ulcer in middle, slowly shrinking.  I am very nervous and scared as I am single and quite sexually active, although I do use condoms (I am gay).  

[Edward W Hook, MD]

In your case means just what it says. My assessment is based on application of the data based the information you have provided, not generalizations.  

You are correct, I would recommend against wasting your time and money pursuing testing at this time. EWH

[matthewsxy]

I don't understand what you are saying after "in your case .  .  . "

Are you saying it wouldn't show after weeks or months?  

Sounds to me like you are saying that there is no definitive test for recent outbreaks, so nothing i can do now, and also that there is no point in my ever getting tested again unless I have a truly suspicious symptom or an hsv positive partner because it would just be a waste of time and money because there is so little likelihood that I have it.  

Am I understanding you correctly?

Thanks again, so glad you guys are out there.

[Edward W Hook, MD]

We would not recommend additonal blood tests. The test is useful in selected situations in which there is a suspicous clinical presentation (yours is not) or if a partner is known to have HSV.  In your case, the most likely outcomes are that either you woul find out that you already have the infection or you would have a false positive result. The likelyhood of diagnosing recently acquired HSV is among the statistically least likely possibilities.

There is excellent, highly informative information on HSV available at the web site run by the American Social Health Association.  (Disclosure. Dr. Handsfield is, and I was, a member of the American Social Health Association Board of Directors.)  Alternatively you could use the search function on this site to seek other interactions about HSV and HSV prevention- there are many.  EWH

[matthewsxy]

Oh yes, and to add . . . this blister was uncomfortable for about the 20 minutes from when I found it to when I "popped"/opened it.  For example, on the car ride home from the gym, it stung a bit as I was sitting on it.  Felt weird.  Not much discomfort in the three days since it has been popped though.  Just stings a bit in the shower since yesterday when water is run over it.  Other than that, I don't really feel it.

[matthewsxy]

Thank you.  So do you don't think I should get blood tested again in 6 weeks for HSV?

Also, I do not know of anyone that I have had sex with who had HSV, but I have had quite a few different partners (unprotected oral and protected anal (me being the inserter)) in the past three months and many of them have been strangers.  Does that constitute possible exposure?  It says all over the internet that 1 in 5 have it and don't know it or show it.  

My main concern is, should I just move on and get on with my fairly safe, but adventurous, sex life, or do I now, because of this blister, have a moral obligation to do more testing in the future to make sure I am not spreading HSV to others?  If so, when?

And lastly, is there one of your posts or another source of information where I can find really good information about how to prevent myself from ever getting HSV if I don't have it??

Sincere thanks for your time, once again.

[Edward W Hook, MD]

Welcome to our Forum.  I'll be please to comment.

For starters, there really is nothing here to suggest herpes. You do not have a history of exposure and the lesions you describe are not typical of herpes lesions which tend to be uncomfortable and are groups of small blisters, not solitary lesions.  Your IgM test is meaningless.  The IgM tests for herpes are extremely unreliable and tend to give many, many false positive results.  The CDC specifically recommends against IgM testing for HSV because the tests are so unreliable.  We agree.

As for your rash, if it continues to appear, I would suggest you speak with a travel medicine specialist. There are several mosquito and tick borne rash type illnesses which can be acquired in Africa.  I would not worry however about HSV.

I hope this comment provides some direction.EWH