Worried if this is herpes (located in perineum area)

[t_from_bayarea]

Hi Doctor, I am a bit concerned if I have genital herpes located in my perineum area. I noticed this whenever I finish a bowel movement. After I wipe, I notice blood on the paper. I looked in the mirror and saw an open wound or cut in this area. Today, after a bowel movement, a lot of blood came out with the fecal matter. And when I wiped, a large amount of blood was on the paper. I dont have any pain during bowel movements. It does hurt like a cut when I wipe that area or spread it open. I dont have any bumps or lesions or warts on my penis or anywhere else. I do have occasional itching around my testicles but no bumps or warts or rashes. I just have this problem in my perineum. I applied Neosporin on the affected area. I included pictures below:

http://img135.imageshack.us/img135/7355/dsc03602zy1.jpg

http://img89.imageshack.us/img89/2640/dsc03607hv4.jpg

http://img171.imageshack.us/img171/5972/dsc03603fa2.jpg

I was tested for the full gamut of STD's and were negative on all of them. I was NOT tested for HSV1 or HSV2 however. The clinicians said that there isnt a really good test for it and can only be diagnosed if herpes lesions, bumps, sores, etc. are present.

I was also concerned if I had contracted HIV. I was tested after 90 days via the Rapid Oraquick Oral Swab HIV1 HIV2 test with negative results. Yet, I still have this concern that I have contracted it and have been riddled with anxiety ever since. Since my STD and HIV testing, I have had received protective oral sex with a few other women but no full intercourse. But all this stress occurred after a massage parlor sexual encounter 90 days before my Rapid HIV test. It was protected oral and vaginal sex with her giving me bareback hand release afterwards. There was slight condom slippage during intercourse, but not fully off my penis, just moved up as I lost my erection. I was worried that her fluids could have infected me if there were any cuts or dry skin present on my penis. I did shave my penis before my massage parlor sexual encounter. I dont believe there were any bleeding or cuts present. Maybe a little dry skin.

Thanks doctor for the time in reading this and thanks for your help.

Also, I am currently having shortness of breath symptoms and chest tightness. Could this be caused by an STD, HIV or just stress and anxiety? I have not had any weight loss or fever. Thanks.

[H. Hunter Handsfield, M.D.]

Sorry, I don't look at posted photos.  In my view, it comes too close to practicing medicine from a distance.

You describe classical symptoms of an anal fissure.  It's extremely common, and although herpes sometimes contributes to some fissures, most cases are not due to HSV.  If your lesion was due to herpes, it would come and go--i.e., it would last a few days, then would totally clear up for at least 1-2 months, then come back.  Also, herpes lesions rarely bleed.

You clearly don't have HIV if your Oraquick test was done at least 6 weeks after your last possible exposure.  In any case, none of your symptoms is particularly suggestive of HIV.

See a health care provider to check things out.  But I see no reason for you to be worried about either herpes or HIV.

Good luck--  HHH, MD

[MLWTR]

An anal fissure or hemorrhoids could cause a little bit of bleeding when you have a bowel movement. But if you actually have blood mixed in with the stool, you really need to see a doctor. This could be a G.I. condition (not sexually transmitted) such as Crohn's disease or ulcerative colitis. Crohn's disease can also be associated with fistulas in the perianal area (small openings that can leak blood or stool).

Hope you feel better soon.

[Englishman]

Not an STD. Anal fissure and anxiety fit your symptoms. You need to go to a doctor and get it looked at. Same happened to my mate a few years ago - he turned out to have an anal fissure. He was given cream and told to change his diet to include more fibre and fresh water. Best of luck.

P.S. The doc will not look at photos.

P.S.S I'm not a doctor, this is just my opinion.

[t_from_bayarea]

Thanks everyone. The blood in stool was just the blood that came after a very hard stool. It badly aggravated the cut below my anus. That was the only time blood came out. Otherwise, I just get normal bleeding each time I wipe that area.

Well yes, my anxiety has taken the best of me regarding STD's including HIV. Hopefully this thread and your reply has put my anxiety to rest. Thanks again Doc. I will see what happens as I continue to use a topical anitbiotic to help heal the cut.

[Englishman]

You should still see a doctor and get the appropriate treatment. My mate had a camera up his arse and got a free jar of special lotion and it sorted it out over a few weeks. Definetely better than self treating. Good luck.