Genital Herpes Right Under Belly?

[ajmccarthy]

30 year old male, no major health issues to speak of, in fairly good shape, living with girlfriend of 3 years, also no health issues to speak of. I had complete blood work done during a physical 6 months ago, full STD screening, all negative. Girlfriend STD tested last year, all negative.
Ok, about 5 days ago I noticed two slim, parallel 1/2 inch long red marks just below my belly line. Not in my pubic area but above it. The marks are 2 inches southwest of my naval. They felt and looked like a burn you might get if you touched an iron or bumped into a hot stove accidentally. (I haven't). 3 days ago the lymph node in my groin began to swell and became painful. Seeing as my underwear, pants and belt are all literally rubbing the marked area all day long, I figured it was just a scratch that I was making worse due to every day movement. I decided to go to the doctor this morning just to check it out and after a very brief look at it he said "genital herpes" and sent me out the door with samples of Famvir. I freaked. He said it can only be from sexual contact at which point I stated that I am fairly certain that I'm clean and my GF is clean that we were not sleeping around. He took blood and told me to call next week.
Seeing as 25% of the population has genital herpes, I guess anything is possible but I have had zero discomfort, itchiness, burning or swelling anywhere in my pubic area or on my penis. I shave from time to time down there. My GF and I are both floored and upset. Any advice?

[H. Hunter Handsfield, M.D.]

The location and your description of the rash is atypical for genital herpes but possible; genital herpes outbreaks can occur anywhere in the 'boxer shorts' distribution.  But you description of the lesions is not typical for herpes.  The lymph node inflammation in the groin could occur with just about any inflammatory skin condition in that area, herpes or anything else, so that doesn't help either way.

All in all, I would not have thought herpes likely; and with shaving in the area, follicultis or other superficial staph/strep infection would be a good bet.  However, if a provider is experienced in recognizing herpes, visual diagnosis usually is accurate.  What bugs me is that apparently your doc did not test you for HSV, which wa a big mistake.  (At least you don't mention being tested.)  Given the atypical location, lab testing to confirm the diagnosis should have been routine.  Further, every case of herpes needs to be tested to determine HSV-1 versus HSV-2 as the cause; the natural history (frequency of outbreaks, asymptomatic shedding and risk of transmission) are very different for the two viruses.

Your 25% statistical quote is accurate, and most people indeed do not notice symptoms, so that in itself doesn't argue against herpes in you, your partner, or both.  If your rash has apparent vesicles (clear-fluid blister-like lesions) or pustules (same thing, with cloudy fluid or pus), immediately stop the Famvir and see your doc or another provider immediately for testing for HSV.  If the lesions have healed beyond that point, though, testing for the virus now is pointless. In tha case, both you and your partner should visit a provider for HSV blood tests.  That will tell for sure whether either or both of you is infected with HSV-1, HSV-2, or both.

Best wishes-- HHH, MD

[ajmccarthy]

Hi Doc,

Thank you for the response. The doctor simply took blood and told me to call on Monday. Not sure if this is the testing your referring to as he didn't really give me any details. This is truly unsettling. The weird thing is that yesterday, the area was very red and hurting but today hurts less and looks to be shrinking. I've had no pus or discharge, the two spots are just red, now pinkish. If this was a true outbreak, wouldn't it last longer than 3-4 days? I tried to make another appntmnt today with a different provider but to no avail, I guess Monday will be my next chance to explore.