What could this be, HSV 1 in the genitals?

[RobertA22]

Dear Doctor,

I've noticed some great responses that you've sent to people on health forums online.  I wanted to ask your professional opinion.  For the past 9 years I've had a pain in the tip of my penis, and it gets very red and scaly after any mechanical irritation (sometimes it gets sore and other times just red - it tends to flake off when it is severe from rough sexual activiy).  The redness and shedding occurs quite frequently especially when I am sexually active (can happen several times a month).  There is a tingling in my scrotum as well.  The tingling in the scrotum occurs several times a week, every week.  There are not always visible symptoms of scaly redness since that is brought on from sexual activity.    I also have a sharp pain in my uerethra from time to time.  I first started noticing these symptoms 1.5 days after receiving unprotected oral sex (could've been a coincidence).    

I've seen several doctors, dermatologists, urologists, general practicioners, etc....all with no diagnosis.  I've been told this is possibly dermatitis with no explanation as to why my scrotum would tingle.  I've had my prostate checked and I've been tested for Chlamydia, Syphillis, Gonherria and almost every other std in the book.   My blood test for HSV 2 came back negative, HSV 1 was positive, but I had cold sores as a kid, and I was told that I cannot contract HSV 1 in the genitals if I had the virus orally already.  Anyway to determine the location of HSV 1 with a blood test?  I cannot figure out what this is and I've had it for 9 years now.  It is really affecting my life.  Have you ever heard of anything with these symptoms (tingling scrotum, redness at tip of penis and occasional pain in the uerethra - primarily after sexual activity)?  Could this be an HPV infection or Bowen's Disease?  Please, any input you could offer me would be greatly appreciated.  Thank you very much!

[Edward W Hook, MD]

Welcome to the forum.  I will add a few comments to those that you have already received from other physicians.  I suspect my comments will sound like comments you have heard before.  

As you were describing the flaking rash that you get and the fact that it seems to follow sexual activity, I found myself thinking that this sounds more like a dermatitis of some sort than anything else.  There are a number of different dermatological processes which can be chronic in nature and which can get worse following minor trauma such as the friction associated with sex.  Among the things that could appear as redness and flaking are both psoriasis and fungal infections as well as a number of other dermatological processes whose names are beyond my expertise.  For any of these problems, it would not be outside of the realm of possibility for them to also involve the scrotum and cause itching in the area.

The rash and symptoms you describe are not suggestive of HSV.  As you already point out, your HSV infection is manifested as cold sores and you have no evidence that you have HSV-2.

It is quite natural in this day and age for persons to wonder if genital signs and symptoms might be due to an STD.  In the situation you describe however, I think it is most unlikely.  If this problem was a continuing problem for me, I think I would seek the opinion of another dermatologist to try to get help in sorting this out.

Sorry I don't have a more definitive answer. This is almost certainly not a manifestation of a herpes infection.  I hope my comments are helpful to you.  EWH

[RobertA22]

Thank you for your answer doc.  However, have you ever heard of tingling in the scrotum??....I notice it almost daily.

[RobertA22]

Thank you for your answer doc.  However, have you ever heard of tingling in the scrotum??....I notice it almost daily.  Also the redness has never gone away, it is just always there and the pain in the uerethera comes and goes....

[Edward W Hook, MD]

Please see my comment above.  The scrotal sensations you are experiencing my be due to whatever the process that causes the redness and flaking on your penis is.   Alternately, sometimes as persons examine themselves and they become far more attuned to genital sensations than in periods when they are not concerned.  This in turn leads to noticing what turn out to be normal sensations that might have been not noticed or ignored at other times.  Perhaps this is a contributor to your situation.  those are my thoughts.  EWH

[RobertA22]

Thanks for your prompt responses.   Is tingling in the scrotum a symptom of any STD that you are aware of?  Also, to completely rule out the chance of having HSV 1 in the genitals (I'm almost positive I had the virus manifest as cold sores when I was a kid, but not absolutely certain) - is there a blood test that can determine the location of HSV 1 in the body, ie - oral or genital??  Thank you so much!  

[Edward W Hook, MD]

No, tingling of the scrotum such as you describe is not an STD symptoms.  The blood test for HSV does not indicate location.  You really need to put this aside.  EWH

[RobertA22]

Thanks Doc, however, a sharp pain and redness in the tip of the penis, and an intense tingling in the scrotum are not things that I can put aside.  I'm shocked that no one has been able to diagnose this issue.  Please if anyone else has had these types of symptoms let me know what you've found out.  Thanks!

[RobertA22]

Thank you for your responses Doctor.  I am going to follow up with a dermatologist.  In your experience have you ever heard of HPV causing a tingling sensation in the scrotum?  

[Edward W Hook, MD]

No, HPV is typically asymptomatic and does not cause tingling.  This thread needs to end at this time.  EWH

[RobertA22]

Hello Doc,

Absolute final question, can HPV and/or HSV develop lesions inside a male's urethra?  Or does it have to be a part of the skin that came into contact with the virus?  Your assistance is GREATLY appreciated!  

[Edward W Hook, MD]

Yes but when HSV or HPV occur inside the urethra, they typically also cause external lesions as well.  the time has come for this thread to end. No further questions please.  EWH

[RobertA22]

Dear Doctor,

I am still not convinced that this is not HSV1 in the genitals.  The redness (scaly,bumpy) around the urethra, stinging in urethra and tingling in scrotum has been VERY noticeable everyday for the past 9 weeks.  Is it safe to say this is not an episode of HSV1 in the genitals?  

I've tried so many routes to diagnose this issue and your expert opinion is GREATLY appreciated.  The main reason I'm not convinced is because I don't see what else it could be and I did test positive for HSV1 via blood.  I don't think anxiety could cause all of these symptoms and the pain can get bad.  Thank you SO much doctor!

[Edward W Hook, MD]

You and I have come to different opinions.  You can seek testing for the sites you think are involved with PCR or culture.   The symptoms you describe as well as their duration are just not compatible with HSV.  I have nothing more to say.  Good luck.  EWH

[RobertA22]

Thank you very much doctor.  If you had these symptoms what would you do?  I'm not sure where to turn anymore and I need this pain to go away, plus I am very scared I could be infecting my girlfriend.  I truly appreciate you going out of your way to help me out!