Does this sound like Herpes?

[curious_george123]

Hello Doctor,

I am concerned that I might have caught herpes from a recent exposure with a csw.  On September 21st, I had protected vaginal intercourse.  After the session, she told me that she had a burning sensation down there.  I didn't think too much of it and thought that she might just have an UTI or was just sore from having too much intercourse.  9-10 days later, I began noticing white dots near the base of my shaft and some small bumps in the pubic area.  I initially thought that this might just be a case of folliculitis, but then I noticed a pimple like blister in the crease between my upper thigh and pelvic area.  After noticing that, I freaked out and tried to pop it.  Upon popping it, saw some blood and clearish fluid.  It's been a couple days since I've popped it and the area is still raised.  The white dots on my shaft are still there.  The bumps around the pubic area have almost gone away.  They are about 0.5-1mm in diameter and there are about 3-4 of them.  The white dots don't hurt when I touch or rub them and I don't feel any discomfort when I pee.  The only discomfort I feel is from the pimple or blister that I forcefully popped.  I was completely pain free prior to touching the pimple/blister.

[Edward W Hook, MD]

Welcome back to the Forum.  I'll try to help.  

The lesions you describe do not sound like "classical" genital herpes which is typically at least somewhat uncomfortable and is often accompanied with local lymph node swelling and/or flu-like symptoms.  The sound much more like folliculitis. The problem is that some herpes can present in atypical fashion.  The best and most direct way to address the possibility that this is herpes is to go see a health care provider who can perform a herpes culture or PCR test.  Do not let them try to convince you that there is no need for testing or that they cannot culture a lesion. If there is a lesion present, even if it does not have fluid in it, it can be cultured.

Several other suggestions- you may wish to contact your partner and ask of her health.  That she was sore during sex is worth following up on.

In addition, I should add that condoms markedly reduce the risk for acquisition of herpes, also making herpes more unlikely.

Sorry I cannot give you a more definitive answer. Testing is the best course of action. EWH

[Edward W Hook, MD]

I ended this thread several exchanges ago and apparently made a mistake in trying to reassure you after doing so.  What you describe in NO WAY suggests herpes.  You need to work with your dermatologist to address what may be going on and to figure out how to get past your totally unwarranted concerns about HSV.  Clearly you are having trouble getting past your fears about herpes.  If you cannot believe any of the multiple health care providers who have told you that this is not a concern, I suggest you discuss this with a mental health professional- this fixation is not warranted and not doing you any good.  I say this out of conern, nothing more.

Further comments will be deleted without comment.  EWH

[curious_george123]

Dr. Hook,

I wanted to provide an update for my status and hear of your input.  I had a culture of the lesions on my buttock and it came out negative for herpes and shingles.  My PCP prescribed some clindamycine phosphate gel.  I began to apply it liberally around the buttocks and pubic area, but the condition did not improve.  My dermatologist then prescribed doxycycline at 100mg 2x/day.  I'm on my 7th day, and although some lesions in the pubic area have subsided, others have now feel like small lumps under the skin.  Last week, I noticed 2 more lesions on the shaft of my penis -- these lesions are about 1mm wide and have a black dot in the center.  Two days ago, I noticed a small red patch on the head of my penis that now formed a small, red bump about 1 - 2 mm wide.  These lesions are not itchy and not painful.  
Since the lesions on my buttocks were determined to be negative for HSV via culture, I'm now wondering if the lesions on my penis and pubic area could be something completely different? Do the new lesions on my shaft and "dome" sound like herpes? It's now about 20-22 days since I've noticed the initial lesions in my pubic region.  If these were herpes, would they at least start healing and scabbing over by now instead of still being red and some being just hard bumps under the skin? Thank you.  I convinced my PCP to put in paperwork for an IGG test, but at 4 weeks post exposure, it's probably not much use for me, yet.

[Edward W Hook, MD]

No, to all questions.  EWH

[curious_george123]

Hello Dr. Hook,

I'm sorry for prolonging this thread.  I hope you can provide me with your insight on this last question.  None of those pimples/blisters that I have mentioned in the previous thread have opened up into sores or blisters, so I was suspecting that it might not be herpes; however, yesterday, I began to develop rashes on my left buttock which are quite itchy.  Some rashes are right underneath the waistline and some are 2-3 inches below it.  They do not hurt.  I've read that herpes outbreaks can cause rashes on the buttocks.  My followup appointment with my dermatologist is next week.  Does this sound like herpes? Does the outbreak of herpes rashes and blisters on different locations over a span of a week and be non- localized?

[Edward W Hook, MD]

You are getting carried away aand off topic.  This will need to be the final answer.

If the lesions you have noticed at warts, they are NOT from an encounter just 15 days ago,   On average warts take 6 months to appear.

Herpetic blisters break open within a day or two of appearance.

this will conclude this thread.  EWH

[curious_george123]

Hi Dr. Hook, I was reading the causes of genital warts and noticed that it usually takes months for warts to appear.  Does this mean that my outbreak of warts was probably from an encounter that is unrelated to the one that I had  roughly 15 days ago? Maybe I'm being overly obsessed with my genitalia, but I've found a few more tiny "shiny" dots in the pubic region.  Still no pain or discomfort whatsoever.  How long do herpes blisters usually take to break open?  

[Edward W Hook, MD]

Thaks for the follow-up.  Glad to hear your doctors are working with you on this. EWH

[curious_george123]

I just returned from my PCP appointment.  She referred me to a dermatologist who, by visual inspection, said that the lesions on my penis are not fluid filled and was confident that they are genital warts.  I showed her the lesion at the top of my thigh and she says that it is folliculitis.  She did not take any samples or conduct a PCR test.  She also stated that they are not herpes because I did not feel any pain or discomfort with the lesions.      

[Edward W Hook, MD]

Glad to hear things are looing up.  Over 80% of genital herpes lesions occur towards the end of the penile shaft.  Lesions in the public area and thigh are much more likely to be folliculitis.

BTW, when you see your PCP, I recommend against a herpes blood test.  It is too early for such a test to be any help.  EWH

[curious_george123]

Thank you, Dr. Hook.  I just called the CSW and asked her about her condition.  She says that she feels fine and that I can come and look at her if I'd like.  This makes me feel a bit better coupled with the fact that I've had multiple bouts of folliculitis in the past.  Regardless, I have made an appointment with my PCP tomorrow to double check.  By the way, would blisters from a primary outbreak usually be present away from the shaft and in the area between the upper thigh and pevlic area? Thank you for your input.