second guessing, herpes fissure q.

[dmc813]

I have a painless, almost colorless, flat lesion on the foreskin area of my penis.  The area in total is about the size of a pencil eraser though the shape is not uniform. The edge is only very slightly raised and the sore seems almost slightly recessed, like a fissure. When I pull the skin tight it is difficult to see, but I can see the outline and the sore itself seems to reflect light more (it is NOT filled with fluid, or noticably different in color). When I relax the skin the sore is almost impossible to see but  is slightly more red than the surrounding tissue.

I saw a dermotologist yesterday (4 days after discovery of the lesion) who said it was probably a "striae" but DID prescribe me hydrocortisone 2.5% cream.  Derm said to use the ointment for 2 weeks, and if nothing changed it was probably just a striae that would be there for good.

I dont want to be paranoid, but at the same time do want to be thorough and responsible.  My last sexual incounter was vaginal and unprotected on Sept 23rd. (almost 3 months ago) It was a one night stand and she was only my second partner lifetime.

I understand a painless fissure would be an atypical presentation of herpes, and I also understand that I should have experienced a primary outbreak before now if herpes was indeed the culprit.

My question is 1- how probable is it that I had a primary outbreak without noticing, but would get a recurrance in the form of a totally painless fissure on the forskin just below the head of the penis? 2-Should I avoid sexual contact (oral, hand jobs, ect) until I have waited a couple of weeks? 3-If this is a recurrance how long before I should see the fissure dissappear?  I think about a week? and lastly, 4-Should I even be second guessing the derm?  The only reason I am is because she prescribed the ointment even though it wont help if the fissure is in fact a striae.  I guess I dont feel as confident in her diagnosis becuase of that.

Thanks for the help!

[Edward W Hook, MD]

Other than the fissure, the lesion that you describe is not in any way suggestive of herpes.  You are right that occasionally recurrences of genital herpes can appear as fissures but for this to happen in the "company" of a flat colorless lesion moves it away from this possibility.  When these recur, the lesions typically heal in 3-4 days so again, that you lesion has been there five days at the time of this writing again suggests that this is not herpes.   In answer to your specific questions:

1.  Persons can become infected with HSV and then have their initial manifestation appear as a recurrence.  When the do, the lesions are typical in appearance.
2.  No need to wait.  This is not herpes.
3. If it was a recurrence, it would be gone by now.
4. I would not advise second guessing the dermatologist.  She is an expert in skin conditions.  Sometimes in medicine when we deal with minor problems we have two options--spend a lot of the patients' time and money pursuing the diagnosis of something that is of no consequence or simply treating it symptomatically.  I think that her sense of what is going on is likely to be right.


Again, this is not herpes. Nithing about your history or description fits and you have been examined by a dermatologist who appears to feel the same way.  No need to worry.  EWH

[dmc813]

thanks Dr, I appreciate your insite.  I was wondering if you had any guesses as to a possible cause?  I would be happy to pose a new question if I need to, but Im looking all over the place for something resembling what I have and am coming up empty so I finally came back.  

[Texas55]

A related discussion, penis fissure was started.