Single Blister/Pimple; symptoms question.

[ShoreThi]

Dr. H; thank you for all the good work that you do.  I am a 24 year old male who recently engaged in unprotected genital-to-genital contact (no full-on penetration, but vigorous and extended rubbing all over the genital area) with a female of similar age. Three days after this encounter, I began to experience joint/muscle aches, lower back pain, headache, malaise, sore throat, and overall 'out of it' feeling.  (No fever.)  Diffuse genital itching accompanied these symptoms, but no signs of lesions in these areas.  (Just scaly, dry skin.)  As of today, general malaise still exists, but to a much lesser degree.  All other symptoms have for the most part subsided.

Two days into these initial feelings of illness, I woke up and noticed a single, small 'pimple' at the base of my penis, in the hair follice area, two days following my initial symptoms.  I 'popped' it, (yellow pus discharge), and applied pimple cream.  Today, I still noticed it being slightly swollen.  I squeezed it again, and it 'popped' once again, this time with a white 'pus' discharge.  This is the only potential 'lesion' in my genital area, with no clusters or spreading.

I know that long-distance diagnosis of a skin lesion is next to impossible.  However, per the symptoms and description of my situation, what is your opinion regarding this potentially being an initial HSV-2 outbreak?  I know for a fact that I did not have HSV-2 prior to this contact, and am already HSV-1 positive.  I know this contact was not high-risk, but I still have some concern due to feeling unwell and having this coincide with those same symptoms.

Thank you for your help.

[H. Hunter Handsfield, M.D.]

Your description of your skin lesion is very clear -- and it doesn't sound like herpes.  Location:  first-episode genital herpes usually involves the penis itself, uncommonly in hairy areas -- but that location is typical of pimples, hair follicle infection (folliculitis), etc.  No. of lesions:  although a single lesion certainly can occur, herpes usually presents with multiple lesions.  Description:  Within the first 1-2 days, herpes lesions do not contain pus, just clear fluid; a pustular stage occurs later (a few days), but even then herpes typically doesn't have the thick sort of pus you seem to imply.  In addition, herpes lesions are quite superficial, compared with the deeper lesion (suggested by the persisting "bump" a day later) of a pimple etc.  (Think of herpes lesions as being "on" the skin, with pimples etc as "in" the skin.)

As far as feeling unwell, I doubt that it has anything to do with the pubic skin lesion.  And herpes of the genitals would not cause a sore throat.  Sounds like you caught a cold, nothing more (perhaps from your partner, although just as likely unrelated to that event).

Of course see a health care provider if your symptoms persist or if others (e.g., additional genital area lesions) appear, or if you remain uncertain.  But if everything clears up in the next few days -- as I predict they will -- I would just let it go.  I see no serious likelihood of herpes.

Best wishes--  HHH, MD

[ShoreThi]

My initial lesion (assuming it was a pimple) cleared up within a week of this posting.  However, within the last two weeks, I have had a recurrent itchy spot in the area between my genitals and my inner thigh.  I took a closer look today, and noticed a solitary, dark red spot (about the size of a pin) in that area.  Does not look like a pimple, no scab on it or anything like that...just a maroon colored spot on my skin.  Not a mole, though.  Anyway, it seemed  contrary to all I have read regarding HSV, as in, it would be an extremely strange place for a lesion....does this sound like anything suspicious to you at all?  Thank you again.

[H. Hunter Handsfield, M.D.]

"Anyway, it seemed contrary to all I have read regarding HSV, as in, it would be an extremely strange place for a lesion."

I agree with both points.

"Does this sound like anything suspicious"?

Not suspicious for herpes or any STD.  Sounds most like a localized bacterial or fungal infection.  You might try washing with soap and water a couple times a day, plus an over the counter antifungal cream of the sort used for jock itch (look in the same section as athletes foot products or ask the pharmacist).  If the rash is deep in a skin fold (for example, If you overweight) and doesn't get much air, also consider talcum powder or cornstarch to keep the area dry.  If it doesn't clear up promply with these measures, see a health care provider.  But don't worry about herpes or STD.