White head on head

[concernedaboutazit]

Please help!

I am a 35 year old male who had 2 sexual encouters 2 weeks ago with the same girl (once protected, once unprotected).  After 4 or 5 days I noticed a single, whitehead pimple on the left side of my penis head.  I did not think much of it since it looked like any typical pimple.  I continued to masturbate throught the weekend and by the following monday (this week) my shaft developed some raw spots (the skin may be split, but there is not mucus, pus, and very little if any discoloration).  In the area of the raw spots the skin started to swell.  Back to whitehead-it has continued to diminish in size like any normal pimple, became a red bump and had a tiny red spot where the white part was-its almost gone now (thursday).  My penis continues to have a slight tingling sensation, but that comes and goes and maybe because of putting neosporin all over and my mind running.  I went to the doctor yesterday and he said the pimple looked like hsv , the raw spots looked like nothing, and took some blood, but I am too worried to wait.

My issue with the potential hsv diagnosis is that from reading about the symptoms I do not display many of them, including:  single pimple, whitehead-i.e. certainly didn't seem like a blister, no flu like symptoms, my penis feels raw but there was no tingling before the pimple (in fact no symptoms at all prior to the existence of the pimple), no pain urinating, no fever, I have seen no pictures that look like my whitehead concerning herpes,etc...

I'll get my answer soon enough, but haven't been able to sleep so I was hoping you could provide some insight.

I have never had an outbreak before (that I know of so I'm guessing this would have to be the initial outbreak - though my Dr. said maybe I had an initial outbreak and didn't even notice-I thought they were supposed to worse and I have never had anything like this before).    

Thanks,
WR

[H. Hunter Handsfield, M.D.]

I agree with the nurse.  Most likely, your HSV-1 infection -- which half of all adults have -- is oral, likely acquired sometime in the distant past

Thanks for the thanks.  Glad to be of help.  

[concernedaboutazit]

Well, I got my test back, finally, and the readings were as follows:

IGM 1/2- Negative she didn't give me numbers
IGG HSV1 - 2.97
IGG HSV2 - .32

Conversation with the nurse (after she consulted with the doctor) basically went as follows:
Positive for HSV 1, but probably not the reason for the zit (sometimes a zit is just a zit), and unless there was any other concerns with my recent partner, the combination of her history (including her prior negative tests) and the IGM results means there is little reason to worry-from everything I have read I agree-do you?

All that being said, I know that it is impossible, to try and make specific recommendations/diagnosis over the internet, especially when the patient has already been to a doctor and is merely waiting for the results, however, I have found this site to be extremely useful and I want to thank you for the information you provided me and other posters.  I certainly feel more much more knowledgeable about STD's (herpes in particular) that will help me live a more responsible life.  Thanks.

WR

[H. Hunter Handsfield, M.D.]

1) Correct.
2) Correct on both counts; not enough time to judge.
3) "Odd"?  I don't know.  This doesn't change anything either way.
4) Most people with herpes never have symptoms at all, either initially or when they have recurrent outbreaks.  Many of them probably had mild symptoms that they ignored and/or forgot about, but some infections are truly asymptomatic.  Some of those with no recognized initial symptoms do notice symptomatic outbreaks later on.  I don't know whether this is your situation or not.

Don't overthink this.  The answers to your additional questions aren't going to make any signficant difference in judging whether or not you have herpes.  Until the test results return, it's speculation and the replies don't change anything one way or the other.  Let's hold off on further questions until the results come in.

[concernedaboutazit]

I tried to wait until my tests came back, instead of using your time, but they keep delaying the results and I keep getting new info and more anxiety.  New info is as follows:
1.  Spoke with my partner ans she is certain she is clean (tested recently).
2.  whitehead pimple completely healed by friday and all that remains is a "scar-looking" spot where the pimple used to be.
3.  All raw spots have healed but one.  No scabbing ever.  The one that remains is a 2 centimeter circle in the skin and in the middle is more dry skin (i.e. no discoloration - etc..).  It does seem to be getting better and the swelling is almost all gone and definitely no scabbing.

Questions:
1.  If my partner is correct you said that lessens the risk, but I could also be having a recurrent outbreak and the sex with her was just coincidental-correct?
2.  I have read that the scar-looking skin where the pimple/sore was is atypical for hsv - is that correct or has there not been enough time to judge?
3.  Is it odd the sores showed up over the course of 3-4 days (pimple first and raw spot 3 days later), and that they are disappearing at varying times?
4.  Finally, and this it I promise, I have read where most people have an initial outbreak within 2-20 days of contact, but also, that most don't realize they have hsv until a recurrent outbreak - seems to contradictory?  Does this mean anything in regards to the situation and schedule of events that I have described?

Thanks for all your help,
WR

[H. Hunter Handsfield, M.D.]

It seems quite a coincidence that the raw places happened to be near the whitehead.  Herpes doesn't typically cause such lesions.  However, if lesions were about to develop, the skin might have been fragile -- so what seemed to be raw spots from friction conceivably could be herpes lesions that were uncovered, i.e. that the friction opened lesions that would have become blisters a day or two later.  But that's only conjecture.  Against the herpes idea is your description that they are healing without scabs.

Bottom line:  Sorry, I don't know.  You'll need to rely on the test results.

[concernedaboutazit]

One last question if you don't mind.  The raw spots I mentioned before on the shaft - is that a potential sign of hsv or is most likely unrelated.  I am confused in that can the splitting of the skin could be considered a genital ulcer (I think from what I read) which seems to be a sign of hsv, however, my gp kind of blew it off and it is in a different location than the pimple and I thought most outbreaks were somewhat localized (shaft as opposed to the head) and there has been no changes to the raw spots (just seem to be healing without scabbing or blisters, etc...).  Thanks again.

[H. Hunter Handsfield, M.D.]

I saw this comment before I replied above and have nothing additional to say.

[H. Hunter Handsfield, M.D.]

I would like to help, but you pretty much outline the issues yourself.  The minute details you describe about the appearance of the pimple-like lesion, either intially or after it got rubbed and massaged, don't help very much.  It is true that initial genital herpes usually doesn't start with a single lesion, but there are plenty of exceptions.  Pimples are uncommon on the glans (although quite common on the shaft of the penis) -- but there are exceptions there as well.  A doctor's opinion that "it looked like herpes" has to be taken seriously, but even herpes experts make mistakes in predicting whether or not a particular lesion is herpetic.

From your description, apparently your GP did not collect a specimen from the lesion for culture or PCR test to detect HSV.  That would have been ideal, but usually isn't useful once a lesion has started to heal.  An HSV blood test hasn't had time to become positive.  If you have had HSV for some time and the current problem is a recurrent outbreak (even though you never noticed earlier symptoms), the test will be positive.  If you have a new infection, the test will be negative.  In that case, if your doctor continues to suspect herpes, you can have another blood test in a few weeks to see if it turns positive.

In the meantime, you should also discuss this with your partner.  If she has no history of genital herpes, she might want to get tested herself.  Obviously, if she doesn't have herpes, that would lessen the chance that herpes explains your problem.  And finally, talk to your GP about a syphilis blood test, if that hasn't been done.  Although syphilis doesn't usually cause a pimple-like lesion, this still might be a possibility.

I hope this helps.  Best wishes-- HHH, MD

[concernedaboutazit]

BTW, when my GP said it could be hsv, whitehead had already gone and all that remained was a red bump with a redder spot in the center where the white head used to be (the red spot was the size of a pen tip).  The spot had been brownish-gray that morning but I picked at it before the Dr.'s visit.  Just wanted give you all of the facts.

Thanks again.