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Possible HSV2

Good Afternoon Doctor,

On 9/14 and 9/24 I engaged in vaginal sex (wearing a condom) with two partners of unknown STD status.

On 9/26 my hand brushed against what felt like a small scab in the hair bearing area .5 to 1-inch above my penis shaft. Upon closer examination, I touched the scab and it fell off, revealing a small lesion (3 - 3.5mm in diameter). The lesion seemed to have a little "crater" shape indentation in the center. The general color of the lesion was light pink. I did not detect any fluid or discharge at this time nor have I seen any since (maybe some was present before I discovered the lesion?). The lesion was painless and was not particularly itchy. Today (9/29) it is about 75% healed.

There isn't a hair growing out of the center of the lesion but there is hair bordering it.

It is my understanding that HSV2 could present itself as a single painless lesion.
Do you think that this is Herpes? What are the other possible explanations? How much should I be concerned?

Thank you!
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563773 tn?1374250139
Thanks for posting your query.

I can understand your concern for sexually transmitted diseases like herpes and HPV wart for the single painless lesion on the penis. However few favourable points for you are:

1) The lesion is present on the hair bearing area. This raises the chances of this lesion being due to folliculitis. Folliculitis is the inflammation of one or more hair follicles. The condition may occur anywhere on the skin. It starts when hair follicles are damaged by friction from clothing or blockage of the follicle.

2) Secondly the lesion is painless which lessens the possibility of herpes which is painful. Pain, burning, tingling, or itching occurs at the infection site before the sores appear.

3) Thirdly the lesion is solitary which decreases the chances of herpes further. When signs of herpes occur, they typically appear as one or more blisters on or around the genitals or rectum. The blisters break, leaving tender ulcers (sores) that may take two to four weeks to heal the first time they occur.

4) Fourthly the lesion appeared two days after the protected act of intercourse. The average incubation period for herpes after exposure is 4 days and for HPV (human papilloma virus) is usually two to three months but can range from one to 20 months.

5) The scab fell off when you touched the area, Painless lesions like HPV warts present as cauliflower like structures and do not fall off when skin if rubbed.

Chances are more that the scabbed area could have been due to an irritated hair follicle or a small boil formed due to irritation of hair during intercourse. Since it has healed by 75%, it further decreases the chances of STD’s. You should keep a close eye on it. If the lesion reappears or more appear around the area then HPV warts should be ruled out. Herpes is less likely even in that case. Diagnosis of genital warts is usually clinical, made by visual inspection. There is currently no FDA-approved test to detect HPV in men. Genital warts can be diagnosed through visual examination of the penis and surrounding areas.
Genital warts can be confirmed by biopsy but sometimes we can use an enhancing technique called acetowhitening. This technique involves the application of 5% acetic acid solution to the area of suspicion for about 5-10 minutes. Infected areas will turn white. But this should be done only if any further appearance of sores is there.

Hope that this information helps and hope that you will get better soon.

Wishing you good health.

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