I am 41//male. I have oral HSV-1. I take valacyclovir for suppression. Have not had noticeable cold sores since I’ve taken it. About six weeks ago, briefly received unprotected oral and protected vaginal at a massage business.  I continued with valacyclovir 500mg/twice daily. Thirteen days later, I noticed a small red spot on my groin area about six or seven inches above the shaft of my penis. It looked like a bug bite and then a small pimple. It was hard to tell, but it either had a hair growing out of it or right next to it so I thought it likely was folliculitis — no blisters, no fluid, no scabs or bleeding that I’ve had in cold sores. The pimple appeared to have a white and then dark center. It has now been 25 days since it first appeared but the red spot is still there, although seemingly darker. It isn’t painful and is roughly the same size as when I first noticed it. 

1.  What is the likelihood this is HSV1, HSV 2 or another STI? Would Mpox ever appear this way?

2.  I heard that most HSV cases appear within 10 days.  Could valacyclovir delay the appearance to 13 days? Related—would genital HSV last almost four weeks while I am taking valacyclovir? 

3.  Would you recommend any test in this situation? 

Thank you again. 

I believe I've answered this question for you at another location.  My answer will be the same here.

1.  What is the likelihood this is HSV1, HSV 2 or another STI? Would Mpox ever appear this way?

The risk of any infection with your experience is very low.  MPox would not appear this way nor would HSV

2.  I heard that most HSV cases appear within 10 days.  Could valacyclovir delay the appearance to 13 days? Related—would genital HSV last almost four weeks while I am taking valacyclovir?

Valacyclovir could delay the presentation of symptoms AND antibody test development.  Herpes would not last four weeks with the symptoms that you describe.

3.  Would you recommend any test in this situation

I would not recommend a routine IgG due to the high rate of false positives.  If you really want to test and cannot put this behind you without a test, do the western blot.

Terri

I have two follow up questions.  First, do you have a sense of how often herpes appears in the upper or mid groin area as opposed to on the genitals?  I’ve read so much confusing info on the risk of “skin-to-skin contact” that I would really appreciate any clarification on that. 

Second, have you seen circumstances where a herpes outbreak lasts longer than 4 weeks?   

The small spot I described is still there after five weeks.  I am not sure what it could be but I am anxious about it.  

Thanks again.  

Here we go!

I would not.  You already have HSV 1 so that test would be positive  and we see such high rate of false positives on the HSV 2 test.

I have not and not with the description that you provide.  No

Terri

This is really helpful. Thanks. 

I have read online that HSV can enter the body any place in the genital region that comes into contact with an infected person — including bodily fluid or saliva—and this perhaps explains why condoms are less effective for preventing female to male transmission (eg if a condom does not cover the groin, which contacts skin exposed to another person).  Is this correct info? Are you saying that such a risk may be possible but it is very unlikely? Have you seen this type of initial infection happen? 

Thanks again. 

That isn't correct.  There has to be the kind of tissue available that the virus can easily enter.  That include genitals and anus.  It does not include other parts of the genital region like buttocks or thighs - the skin is too thick for virus to enter. 

Terri