What is this?

[bh007]

I am a 25 year old male and have had diabetes for 12 years now. I need to know if this is possibly herpes. I have had unprotected sex with a female parnter twice without a condom. She did have a boyfriend during this time. She is the first female I have ever had sex with. It has been more than 5 months since this encounter. I haven't had any sores, just a feeling of sickness for a week or two after I had sex. It eventually subsided and have felt fine. My blood sugars were fine but occasionally spiked up in the 200-300 range. After these five months this is the first time I have had a rash on my scrotum. Due to the cold weather I switched soaps, from irish spring to oil of olay, to help with my dry skin from the diabetes. I went ice skating one night and nothing was bothering me. The next morning I found what looked like a white-head/blister the size of a small pea where the groin is attached to the scrotum. Once I saw that I immediately thought I had herpes, being a hyperchondriac doesn't help either. The whitehead/blister was present as a rash started forming all over my scrotum, it looked like the hair follicles were irritated with some itching and burning, also it was redder in some areas. It also looks as though the white postulates are infected. I went to the doctor to have him look at it and he said it could be a allergic reaction to the soap and prescribed me hydrocortisone cream which only helped a little. I have had this for almost two weeks and keep getting more nervous. The whitehead/blister either popped or just went away with no open sores. My scrotum feels like rug burn and is redder than normal on the left side. There is slight pain in my testicle as well. I know I'm prone to infections because of my diabetes and during the holidays I wasn't really watching my sugars. The rash is beginning to flake off and looks a little red where the skin is coming off, there are no blisters though. There is little burning when I am urinating. I do sweat alot in my groin area and use talcum powder to keep it dry. I also had a blood test two weeks after we had sex to check for herpes, and it came back negative. I hear you have to wait 3 months to see if you are infected. The nervousness isn't helping as it feels like constant rubbing and burning on my scrotum. Do diabetics get rashes like this in the groin and scrotum areas? I have had similar problems with the burning before I had sex. Everytime I have a feeling like this I think of the worst possible thing. Am I overreacting, is the nervousness making it worse? Could it be exzema (eczema)? Could it just be a rash and is taking it's time to heal from the diabetes? Please help! Thank you

[H. Hunter Handsfield, M.D.]

After reading only the first 2 sentences of your question, my opinion is that your symptoms are not due to herpes.  The vast majority of people who are worried about herpes because of atypical symptoms do not have herpes.

Now I will read the rest of your question....

Guess what?  No change.  None of your symptoms suggests genital herpes (not even close!) and your doctor agrees.  S/he is in a much better position than I am to judge other causes.  Certainly diabetics are at elevated risk for a number of skin conditions, including jock itch and other genital area skin infections--especially if the diabetes is not well controlled (sounds like your glucose control is borderline at best).

I see no reason for another HSV blood test.  Based on your symptoms and the low risk nature of the sexual exposure, there simply is no chance it will have become positive.  But feel free to discuss it with your doctor; another negative test wouldn't hurt anything.  Follow your doc's advice about other possible causes and treatment of the rash in your groin and scrotum.

Best wishes--  HHH, MD

[ryn21]

The spot you describe sounds more like an infected hair follicle, not herpes.  Outbreaks usually occur on the shaft itself, not the scrotom area.  In addition, your description of a hair coming out of the pimple is a typical description of an infected/irritated hair follicle (folliculitis).  

Although it is possible to become infected with one or two unprotected exposures with the same person, the chances of transmission are low (given she had no lesions or visable sores).  The doctor states that even in relationships where one person has HSV and the other does not, who have "unprotected" sex 3-4 times a week (when outbreaks are not present), the transmission rate between these couples is around 4-5% per year.  That goes to show you how low your chances are of contracting it.