Swollen Inguinal node, should I be concerned

[worriedone4life]

I noticed yesterday afternoon that I have a slightly swollen tender inguinal node, almost the size of a marble on the left side.  Today it is more tender to touch, although I suspect that some of this tenderness is due to my obsessing and feeling of the node.  There is no discharge or lesions in my genital and surrounding areas.  I haven't had any questionable exposures since July 2005 (Condom broke, 1-2 min exposed unprotected with female).  I had testing done within 6 weeks post exposure.  I have been in a committed relationship since.  My new girlfriend was tested 2 months ago, all tests came back neg.  I am an otherwise active healthy adult male.  

Does this single enlarged, tender node bring up any cause for concern?  Could it be a prodome symptom of anything?

Could this have anything to do with a past exposure from back in early July 2005.

Would a small rash at the bottom of my spine have anything to do with inguinal node enlargement?

Thanks doc.  

Please advise.

[liteonitrelisys]

hi..to be honest im freaking out a bit..im a 20year old student from belfast..and like the guy above ive got a swollen inguinal node (i think...the lump on my groin is bit swollen and quiet tender) on my left side ...i had sex about 10 days ago and the condom broke and the some blood came from the girl (possibly due to rough sex or size etc)...anyway i checked the online diagnosis and it said lump on neck armpit groin...although i think i only have this one symptom...i am very worried and wondering if it is possible to experience these symptoms so quickly if i was infected.....or could i have jus strained my groin during exercise or something?..please help my mind is in overdrive the past two days!!!

[H. Hunter Handsfield, M.D.]

Herpes-related lymphadenopathy is almost always bilateral (both sides) and follows lesions, never precedes them.  You don't have herpes.  See a provider, though.

[worriedone4life]

One more question doc, I promise.  Does inguinal node swelling due to HSV primarily occur after the prodrome and during the actual outbreak?  I have seen on many sites that tender inguinal swelling (on both sides) is usually a later occurance with an outbreak, usually 2-3 days after outbreak begins.  Is this an accurate statement made by these sites?  Thanks again doc for providing such a great service to the public.

[worriedone4life]

Thanks doc!  Waiting for my provider to call back for scheduling.  

[H. Hunter Handsfield, M.D.]

In my STD clinic, at least 100 people come in each year complaining of enlarged, tender lymph nodes in the groin. Those associated with STD almost always have other obvious STD symptoms, mostly genital sores due to herpes or syphilis.  Among those who have enlarged lymph nodes alone, especially if only on one side, almost none have STD.  Infections of the leg or foot--often minor and unnoticed (folliculitis, infection near a toenail, and the like).  And absolutely yes, the rash at the base of your spine could be responsible--depending on the cause of the rash, but especially if it is a bacterial infection like staph or strep.  Another common cause of one-sided lymphadenopathy (the medical term for inflammed lymph nodes) is cat scratch disease, a bacterial infection carried by cats; if there is a cat in your household, that's a pretty good bet.  CSD usually isn't serious but sometimes can get serious.

Certain STDs remain possible, such as syphilis or the rare one called lymphogranuloma venereum.  But both are extremely rare in people with the low-risk sexual history that you describe. Genital herpes is theoretically possible, but rare to have only one-sided lymphadenopathy and no penile blisters, sores, etc.

Bottom line:  See a health care provider about both your skin rash and groin swelling.  To be safe, s/he might suggest doing certain STD tests, such as a blood test for syphilis.  But I doubt you have any STD.

Good luck--  HHH, MD