[Question #1070] Question regarding red bug bite/pimple

87 months ago
Hi, I asked a question a week or so ago regarding HSV testing. At 8 weeks from a potential exposure (do not remember if anything happened, though I don't think so and my friends have said nothing did, nor do I know anything about the person) I have tested negative for everything, including HSV 1 and 2. I am a male and was at a strip club. I am very OCD and paranoid, talking to a psychologist about this. Last night I noticed a red bump that seems like a bug bite or pimple on my left butt cheek. I noticed no other "initial" lesions prior to this. I've tried peroxide and other acne cream on it and other than when I am looking at it as best I can, it does not seem to change. I feel a single center to it, almost beneath the skin. When I am messing with it, it turns more red. I wouldn't say it is painful, but at times it seems to itch or feel like a dull pain, though I am focusing on it.

My questions:

1.) If this would be a recurrent lesion, I read Dr. HHH say on an older thread that these are usually about an inch from the initial lesion. Is this true?
2.) If I was experiencing a recurrent outbreak, would my test have shown positive by this point?
H. Hunter Handsfield, MD
87 months ago
Welcome to the forum. Thanks for your question. I reviewed your discussion with Terri about herpes and agree exactly with all she advised. The symptoms you described there were against herpes, and the blood test results proved almost conclusively that you weren't infected with HSV1 or HSV2 during the exposure event you are concerned about.

As for your new "red bump that seems like a bug bite", it almost certainly isn't herpes. While recurrent outbreaks of genital herpes can appear anywhere in the "boxer shorts" area (e.g. buttocks, upper thighs, etc), the initial oubreak of a new infection almost always appears where the virus enters the body. That usually means the penis in men, vaginal opening or labia in women, etc -- the sites that receive the most friction during sex. (The virus usually must be "masseged" into tissues for infection to take hold.)

Further, herpes rarely appears as a single red bump of this sort. If it were herpes, it would have been very superficial and within a day or two would turn into a superficial blister filled with clear fluid. Any inflamed lesion of the skin will turn more red if pressed or squeezed. That's what pimples do, and that's probably what you have. Keep your hands off and let it go its natural course.

To your specific questions:

1) Not necessarily. Each RECURRENT outbreak typically is pretty near the previous one. The first recurrence following initial herpes can be anywhere in the "boxer shorts" area. However, you haven't had symptoms to suggest an initial herpes infection, so it's harder to predict recurrent outbreak locations. However, my comments above also provide other reasons why this doesn't sound at all like herpes.

2) And yes, your negative test results also are against this being herpes. Probably everyone with recurrent herpes would first have a positive blood test.

I hope this has helped. Given your self-described personality chartacteristics, I would urge you to think objectively. You cannot go through life suspecting every pimple or unexplained red bump is herpes or somehow related to a sexual exposure that you might regret.

Best wishes--  HHH, MD

87 months ago
Dr. Handsfield:

I greatly appreciate the response. I did a second IGG blood test at 10 weeks 2 days and just received word that both HSV 1 and 2 are still negative. I plan on testing again at week 12. I'm unsure of how reliable the test is at 10 weeks and the recommendation seems to be at 3 months/12 weeks.

I consulted electronically with a Dermatologist because it was a few months out to see one in person. I was able to share photos of my bottom and a few other things that were "freaking" me out on my thigh. The Dermatologist said they were minor blocked oil glands/folliculitis that are very common.

1.) Would you recommend testing again at week 16, or even doing the Western Blot? If I understand correctly, it can pick up a few additional cases?
2.) I've had shingles twice, once at 19 (virgin) and second following a stem cell transplant almost 6 1/2 years ago. Would either the shingles or SCT impact the test to incorrectly read negative?

On a side note, I know you deal with this frequently and I've speaking with my therapist about OCD and STDs, specifically herpes, which seems to be a major issue with folks that have OCD like myself. At times, I feel like my brain is broken with this obsession, so this offering of yours is very helpful. Thank you sir.
H. Hunter Handsfield, MD
87 months ago
1) Your negative blood test at 10+ weeks is nearly conclusive. It is very rare that anyone negative at 10 weeks would be positive at 12 or 16 weeks. You can definitely expect another negative result, whenever you do it. And for sure don't have a Western blot. That test is useful to confirm a POSITIVE IgG blood test, especially if only weakly positive. It is not usually recommended at all when the IgG tests are negative; i.e. it almost never picks up HSV2 infections missed by IgG. I recommend against it, especially if another routine test remains negative at 12-16 weeks.

2) Contrary to popular beliefs (and a misunderstanding by many physicians), there is no cross reactivity at all between herpes zoster virus (VSV, shingles) and HSV. 

STDs are probably no more common concerns among people with OCD than any number of health problems. Of course on an STD forum, OCD and STD fears often go hand in hand. But STDs are not the main concern of most people with OCD focused on health issues.

Do your best to let this go. There is no realistic chance you have herpes. Just move on as best you can. And for goodness' sake, stop searching the internet about it. Lay off totally!

86 months ago
Dr. Handsfield, I appreciate your help to this point. I tested negative at 12 weeks, which was last week. Just as I start to feel better in regards to things, I noticed a singular spot this evening. It is on the outer edges of my pubic hair, towards my thigh, but still where there is hair. It is moveable like a skin tag, and is tender/small amounts of pain as I move/"wiggle" it (which I'm not doing, other than when I noticed it). It is red, though it seems like from irritation. Would herpes behave like this or have you seen this clinically (i.e; be movable) ? On a quick search, it seems to mostly be HPV and skin tags, though I can't find much. 

Also, would having the bone marrow transplant or blood transfusions over five years ago impact my test(s) results? Thank you for all of your help.
H. Hunter Handsfield, MD
86 months ago
The "singular spot" you describe for sure isn't herpes, not even close. From your description, I also doubt a wart; probably it's a skin tag.

I'm not an expert in marrow transplants or the diseases they treat. But from what I know, I very much doubt this has any effect on the reliability of HSV testing. For sure blood transfusions do not.

It's time for you to move on. Accept the science and the science-based reassurance you have had. You don't have herpes. And for goodness' sake, stop searching online about it!

That concludes this thread. Best wishes and stay safe.