Need Help...herpes?

[HankHill]

Dr. Rockoff,

I posted on this board 3 years ago and I believe that my posting is the only one that I have ever seen on this site in which you said that the person posting (in this cas me) most likely has herpes.

3 years ago I had an encounter with a female, we did not have sex but she did grind against me with no protection.  4 days later 3-4 small red itchy bumps appeard.  They didn't seem to be fluid filled.  I was able to scrape them away with a pin, but they came back a couple of days later.  Went to the doctor who told me it looked like herpes and gave me a script for valtrex, took it for 7 days and it did nothing.  Three months later I applied Imiquimod on the bumps and they went away in a couple of weeks.  In their place some more bumps showed up almost immediately.  These bumps itch like hell and have been there since they first showed up, about 2.5 years ago.  If I squeeze the bumps, fluid will come out of them and they will scab over.  The bumps will not go away, sometimes they are worse, but they are always there.  The itching is much worse when I have to sit for long periods of time.  

I have been tested for HSV1 and 2 three times via blood test.  I test within or close to the equivocal range for HSV2 each time, but have never tested positive. I tested negative once with a swab.

In addition to the itchy bumps, I have a spotty extremely itchy scrotum, mainly on the left side, but also on the right sometimes.  Nothing seems to trigger it, nothing seems to make it better.  The spots look like my veins have ruptured, almost like there are palips on the veins.  I have tried to squeeze the palips but they do not break open.  Also on the area where the penis meets the scrotum, I develope scabs with no apparent other lesions.  These too itch like hell.

I have been to 7 doctors including a dermo from the mayo clinic.  He seems to want to overlook the fact that I have skin lesions and is trying to tell me that I have a pinched nerve.

In the 3 years I have had this I have tried nearly everyting.  Hydrocortizone, several other steroid creams, anti fungle pills, antifungle creams, imiquimod, antivirals, antibiotics.  I'm running out of hope and don't want to have to live with the itching anymore.  I will do whatever it takes even if I must have the skin from my genitals removed and grafted.

I would like to know what you think this could be. Could it be that I have an a-typical cae of herpes that does not respond to medicine and will never go away.

I'm willing to consider any answer as long as it is not, "Try doing nothing, it is all in your head," because it is most certainly not psychological.  The itching is real, it is severe.  Also I have gone through periods of 3-6 months of doing nothing and it did not help.  I have severely itched for 3 years straight and have had blisters for three years straight.  In your career have you ever seen anything like this?

Please, I'm begging you for an opinion that is different from the other doctors

[HankHill]

I don't have any anxiety over herpes.  I would gladly welcome herpes into my life.  At least that is treatable.

Could chlamydia cause the problems with my blood vessels?  I have read that Chlamydia can cause Erythymia, which sounds a lot like the symptoms that I have.

Also, the scabbing doesn't come from scratching.  Like I said, I have gone through periods of 3-6 months of not doing anything, which includes scratching.

I don't understand why doctors want to overlook the fact that I have awful physicaly symptoms (blisters, swollen veins, redness, severe itching, swollen testicles) and tell me that it is all in my head?  I'm tired of being told that everything is normal.  what tests should I insist on the next time I see the doctor (again)?

[Alan Rockoff, MD]

I don't know what th other doctors said.  Your symptoms are not those of herpes, and of course your negative herpes tests bear this out.  Itchy scrotum is usually either eczema or anxiety or both.  Scabs come about when you squeeze or scratch things.  (You say you "squeeze the palips," but I don't know what palips are.)

You say you are sure it is "most certainly not psychological."  Why are you sure?  You've been to 7 dermatologists, including one at the prestigious Mayo Clinic, and they can't find a physical explanation--why, then, should it not be psychological, at least in part?  Heaven knows I see people in my practice every single day who have physical manifestations of psychological issues, and given your anxiety over herpes, how could you not have psychological issues?

Should you "do nothing?"  Of course not.  You should use symptomatic treatment (lotions containing camphor and menthol as needed for itch, bland moisturizers), you should never pick or scratch--never, not once--and you should consult a psychiatrist to work together with your dermatologist.  Counseling and medication can help you.  You owe it to yourself to get the help you need to get on with your life.

Best.

Dr. Rockoff