A series of strange events - Possibly herpes?

[anon39]

Thanks for looking at my question: Here's a brief history:

1. Have sex mid-late April, condom broke. A week later I notice bumps in my groin area. Given the timeline, I assume herpes.

2. 1st week of May I goto my general practitioner and he can't diagnose, I get STD tests (including HSV-2) and they all come back negative.

3. 2nd week of May I goto the derm who diagnoses me with molluscum. I have the lesions removed and am put on aldara and cimetidine. The area is scabby and tender and in 3rd week of May I recieve unprotected oral from a girl who told me she has HSV-1 from a blood test, but never had symptoms.

5. By early June my scabs and blisters (from aldara and curettage) have healed. After the area is scab free with new skin I notice that the same patch of skin near the base of my penis gets red occasionally and sometimes it looks like there are tiny bumps. This comes and goes until present day (August 14). Sometimes the redness will come back multiple times a week, sometimes it will come back once every few weeks...but it's always in the same area. There's no pain, itching, but my left lymph nodes are enlarged (same side where redness is) but not painful.

6. I see the same doctor this week who refuses to test me because my test in early May came back clean. I told him 2 weeks is not enough for reliable bloodwork results but he insists it is. As a result I have not been tested recently.

What do you think is happening? Is it possible I contracted both MCV and HSV? HSV-2 from April or perhaps HSV-1 due to the oral sex shortly after my curettage? I keep getting the same small patch of skin turning red (sometimes it looks like there's tiny round shape inside the redness). The physical symptoms will often last only a day, then dissapear and reeappear within a month or a few days. I'm very confused. My doctor suggested it may be just be the skin healing from my curettage (the redness is occuring in an area that was curetted) but I'm not sure.

[Edward W Hook, MD]

Less than 3%  EWH

[anon39]

My HerpeSelect tests came back negative for both type 1 and type 2 (nurse on phone did not give a number).

What are the odds I haven't seroconverted at 3.5 months?

[Edward W Hook, MD]

The "patch of skin" is almost certainly not herpes but some other dermatologic (non-STD) process.

As for blood tests, while the average time to convert a blood test from negative to positve is 2 weeks, to pick up most of the tests that are going to become positve, it is recommended to wait unitl 3 months after the time when the concern was raised.  EWH

[anon39]

One more detail: The patch of skin is ON the base of the penis to the left side, not on the lower abdomen.

[anon39]

Thanks for your input. I did indeed have molluscum because I saw the little hard white cores that were extracted from me.

Unfortunately it is extremely hard for me to see my dermatologist because appointments have to be made weeks out, and unlike the molluscum, this small red patch of skin comes and goes as it pleases. I saw my GP today and there was nothing, but two days ago it was there.

Just a bit of clarification: The lesions from April were raised bumps with a white head (core), indeed molluscum. The new "lesions" are just a red patch of skin where the molluscum used to be ....with what seems to a small circle or two (that dont appear to be raised) inside of the red area. I don't know how long it's been happening since the area was busy with molluscum and scabs from curettage. Does this change anything?

If I get an HSV-2 test tomorrow and it comes back clean, it is reasonable to assume I am HSV free? Also, what percent of patients who have HSV-2 test positively after only 2 weeks?

[Edward W Hook, MD]

Ultimately your diagnosis should depend on the results of clinical examination and laboratory tests.  With that in mind, I have several comments.

1.  Herpes rarely presents as "bumps".  The lesions are described as "water blisters" or "vesicles" and tend to break open to form shallow ulcers.  Your lesions last may do not sound like this.  Further, the location you describe would be unusual for herpes.  Thus, from the outset, I am not sure that you have herpes.  

2.  If your dermatologist said that you had molluscum, you probably did.  He/she is a professional and examined (and treated you).  If the lesions the derm treated were similar to the ones you noted in April, this makes it more unlikely that you had herpes.

3.  Your May blood work may well have been too early.  

I would try to get the derm's opinion of your recurring rash.  Once again, without vesicle or ulcer formation it sounds very atypical for herpes and more like some other dermatologic process.

Hope these comments help.  I suspect you do not have HSV.   Another blood test would be helpful for confirming this.  EWH