STDs Expert Forum
Strange Sore
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The STD Forum is intended only for questions and support pertaining to sexually transmitted diseases other than HIV/AIDS, including chlamydia, gonorrhea, syphilis, human papillomavirus, genital warts, trichomonas, other vaginal infections, nongonoccal urethritis (NGU), cervicitis, molluscum contagiosum, chancroid, and pelvic inflammatory disease (PID). All questions will be answered by H. Hunter Handsfield, M.D. or Edward W Hook, MD.

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Strange Sore

Hi, I'm trying to figure out whether some unusual symptoms I've experienced recently have anything to do with herpes. I posted this question about a year and a half ago in the dermatology expert forum:

http://www.medhelp.org/posts/Dermatology/Herpes-Outbreak-or-Fungal-Infection/show/1595847#post_7250562

Based on the advice I received, I stopped worrying about Herpes and went to the dermatologist a few months later for treatment of the fungal infection. They agreed with the diagnosis and advised that I use a milder soap and put an anti-fungal powder in the area daily. I also was prescribed oral antifungals and antifungal cream. I used the medicine as indicated. I'm not sure it helped, the red-lines, and daily itching and tingling continued. I returned to the dermatologist to complain, and they simply said that this was normal for me and that there was no chance the fungal infection survived. The sores at least seemed to stop.

Just about 20 days ago, however, I noticed a sore or two in the perineum, which frequently bothers me, and got a bit worried. The sore was flat and didn't seem to actively weep liquid. The sore(s) didn't hurt, except when the area was touched directly, though it did feel like there was a hair constantly being pulled in the area. No other symptoms  except a mild tingling in the legs. The sores completely disappeared after 2 or 3 days. The sores then left behind hard-ish white areas and on one inspection seemed to have the distinctive herpes crater for maybe a day. Now they are almost completely gone except for a very subtle scar and there are hair follicles growing out of the areas where the sores were.

Bottom line, I'm not sure what to think. I was HSV negative (1 and 2) as of my last test a few years ago and I’ve only had a handful of sexual partners since then, all using a condom. The sores are hard to explain as a fungal infection since it’s supposed to be gone, hence my worry that it’s Herpes. What do you think?
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Welcome back to the forum.

There is little in your story, either now or in your previous threads on the dermatology and herpes community forums, to suggest genital herpes.  The location of the lesions you described is atypical (although by no means impossible) and so is your description of the lesions themselves.

The only other STDs that conceivably could cause this sort of thing are syphilis and warts.  Warts don't cause open sores, but a pre-existing warty area can become irritated and ulcerated, leaving behind the warts themselves as the explanation for the hardened area after the ulcer has healed.  Syphilis is extremely unlikely for a number of reasons, but testing is easy, and better safe than sorry.  (I've never heard of a "distinctive herpes crater", and that description doesn't help me judge the cause.)

There are many non-STD problems that could explain this, but we don't speculate on this forum about problems other than STDs, so I'll leave it at that.

I recommend professional examination, preferably by a dermatologist, and would suggest you have blood tests for syphilis and HSV -- unless the dermatologist is confident neither of these is a serious possibility.  If tested, I predict negative results on both.  Feel free to return with a follow-up comment and let me know the results.

Best wishes--  HHH, MD
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Doctor Handsfield,

Thanks for your you great work here, and especially your thoroughness in reading my other recent posts. I have had a wart, interestingly, but it was many years ago and on the shaft of my penis, thus unlikely to be related to this case. I'm sure the virus from that is quite clear by now and I'm no longer concerned about it.  

For what it's worth, I have already made an appointment with my dermatologist. I would like to see them simply due to their familiarity with my medical history concerning my groin are and its issues.Unfortunately, they're backed up for a while so I've got a bit of a wait while I struggle with my disposition hypochondria. Had anyone said it sounded like a clear case of Herpes I would have perhaps found a way to get the testing done sooner. As is, I'll wait and try my best not to worry, and I will, of course, post a follow-up once I get some actual results.

Thanks again. I imagine it can't be easy dealing with people's intense and irrational fears on a daily basis, especially when those fears are more of a superstitious than a medically-informed kind. You and Dr. Hook deserve more thanks for what you do on here than most of us could possibly manage to convey.
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239123_tn?1267651214
Thanks for the kind words.
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H. Hunter Handsfield, M.D.Blank
University of Washington
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