herpes, molluscum, jock itch

[JMilkman]

found 3 little zits in my pubic area close to the penis shaft back on 12/27/07.  I had no other symptoms at that time and I popped them and cleaned the area with peroxide.  On the 28th, I began to have mild groin pain and went to the ER, where a doctor said I had folliculitis and prescribed 10 days of Keflex, which made no changes.  They also treated me for Gonhorea and Chlamydia as a precautionary measure.  On the 1/02/08, I freaked again and went to an Urgent Care facility where the doctor didn't think it was herpes, but thought it could be the beginning of genital warts.  (He didn't seem knowledgable)  I had tremendous anxiety at that point and asked for some medication.  I was given 10 days of Xanex.  On the advice of the ER doc, I followed up with her friend at an STD clinic on 1/3/08.  She said it was very unlikely that this herpes but did a type specific blood test.  She said it looked like folliculitis.  The next day, I found what looked like two little white heads on the shaft of my penis, close to the head, but on the oposite side of the pubic region where I had found the other stuff.  That night, the spots began to itch, so I popped them and they stopped itching, but came back.  Blood tests later came up negative for HSV1 and HSV2 and I felt OK, but I found a few more tiny scattered zits that cause no other symptoms, so I got in to see a dermatologist on 1/22/08, who put my mind at ease saying he was sure this was molluscum.  He froze each one with liquid nitrogen.  I was walking a lot yesterday and could feel my boxers rubbing on the area of the first zits and they began to itch pretty intensely while walking.  I know this is really long, but is this normal for molluscum?  I notice when I sweat down there, my scrotum burns and I've had a lot of intermiittent problems with chafing, though the only things that are visible are these zits.  Is 4 and a half weeks enough for blood to come up positive?  Thanks so much for any advice; I'm a mess about this.

[Edward W Hook, MD]

I'd go with your dermatologist.  No reason to worry about herpes.  EWH

[JMilkman]

I talked to my dermatologist yesterday and he is so confident that I have molluscum.  I keep seeing that herpes is so easily misdiagnosed and my more generalized symptoms (groin pain, general genital burning, and this prickly feeling in my genitals) seem to be going away as the lesions go away.  Am I nuts or could this still be herpes?

[JMilkman]

Thanks again.  It's hard to accept a molluscum diagnosis because two different experts said two different things and these things have itched twice where I popped them open and cleaned them and the itch went away (I don't really scratch them).  Admittedly I am sometimes getting an itch on my pubic area on the left side where there is nothing visible, so this could be my anxiety, but the itch on the right went away both times that I broke them open.  If it were either folliculitis or molluscum and I applied an antibiotic ointment, could this exacerbate the problem by clogging pores or something.  I'm trying to understand why these 3 pimples would just reform in the same exact place after popping and cleaning them; maybe because of the neosporin I used on them?.  I'll call my dermatologist on Monday, but these questions are driving me crazy.  

[Edward W Hook, MD]

It would be unusual for molluscum to itch but, as I've mentioned, your scratching may be contributing to this.  Since they are viral in nature there is a theoretical chance that they could spread by breaking them however, if this is done while washing, soap and water should keep that from occuring.  EWH

[JMilkman]

Thanks for your response.  The partner that most concerned me was from August, but I had sex with a different partner from late November to early December.  The last time was probably the 7th of December.  The second partner was always protected vaginal sex with a few occaisions of unprotected oral sex, though I don't recall her ever having cold sores.  I just don't understand why the pimples keep reappearing after being broken open and cleaned.  I'll check back with the same dermatologist, but I can't stop freaking myself out whenever something new happens.  And most molluscum information on the internet says they don't really itch.  I'm well aware of the psychological element involved here, but I keep getting reminders that something abnormal is going on in my groin and it's making me nuts.  If I break these lesions when I'm washing, will the infection spread?  And does molluscum itch?

[Edward W Hook, MD]

You say nothing about whether or not there were exposures which contributed to your concern so it's a bit hard to answer completed.  That said, you've been seen by at least three different physicians including STD and dermatology specialists and have been tested pretty extensively.  If the dermatologist says this is molluscum, believe him/her.  In addition, you may or may not have folliculitis but what you certainly don't have is herpes or other STDs.  Specific recommendations:

1.  Molluscum can recur so you may need to work with your dermatologist on this several times.  Persist, don't wander from doctor to doctor.  It is not in your best interest.
2.  Folliculitis also tends to recur.  The key to folliculitis prevention is soap and water, often with the assistance of something like a loofah sponge to help rub away dead skin and keep your pores open.
3.  The more you scratch the more you will itch.  Scratching and irritation, including from treatment, causes itching as part of the healing process.  It's also typical for itching to be worse in the evening, particularly as one tries to go to sleep.
4.  The majority of blood tests will be positive after four weeks.  This in combination with the fact that no one who examined you thought the lesions were herpes means this is not something that should concern you.  Put those concerns behind you.

Hope this helps.. EWH