[Question #1182] Question Regarding Bump on Scrotum

50 months ago
Doctors: Thanks so much for this service, by taking a look, it does a lot for people in a similar circumstance as mine. I am early thirties white male married. For the past 7 years, I have only been with my wife and vice versa. Prior to, we were both sexually active in college, but were tested in the early stages of our relationship. We both also had IGG HSV 1 and 2 testing. I have been negative on both and she is only HSV 1 positive. My wife is now expecting our first, and after foolishly getting a lap dance in June, my STD anxiety from college came creeping back. As a result, I recently had another blood test done, also negative. I understand a small portion of the population does not seroconvert, so I'm concerned I may be in that population and self-examining myself.

Last night, I felt what I thought was a decent sized zit or ingrown hair on the underside of my scrotum that was firm to the touch (towards the anus, not sure anatomically what that is considered). I attempted to see if there was a hair emanating, but it was difficult to tell as there are a lot of hairs in that area. I plucked a few to see if would help and put Mupirocin on the spot. This morning, the spot seemed about the same, maybe a bit less pronounced. In the shower, I tried to pop it, which hurt some and made the spot larger and more sensitive, i.e; aggravated it. I took Ibuprofen and put Hydrocortisone on it to see if it gives any relief. 

1.) In your expert opinion, what causes the small percentage of the population to not seroconvert for HSV testing?
2.) This is one spot, how frequently would HSV show up as multiple lesions? Though I know recurrent outbreaks can happen anywhere in the boxer short area, do most still occur on the penis?
3.) My only option to get this looked at may be going to Urgent Care, as Planned Parenthood is backed out two weeks. Would this suffice?

Many thanks.
Terri Warren, RN, Nurse Practitioner
Terri Warren, RN, Nurse Practitioner
50 months ago
1.  We aren't certain why some people don't seroconvert but in our most recent study, there is decent agreement between the number of people the herpes western blot picks up (a type of antibody test) and the number of people the IgG test picks up - about 93-95% concurrence.  That is, if the western blot was positive for HSV 2, there was a 93-95% chance that the IgG would also be positive. 
you mention a lap dance - was there skin to skin contact with the lap dance?

2.  New herpes would very likely appear as more than one bump on the scrotum - most outbreaks of genital herpes in men appear on the shaft of the penis.
3.  Urgent care or PP would be fine except that now you have changed the appearance of the bump and anyone visualizing it would find it very difficult to give an accurate opinion as to what it is at this point.  I fear that you have made it so aggravated that someone might think it is now herpes - do you know what I mean?

Terri
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50 months ago
1.) There was not. I was clothed the entire time. And my wife has tested negative for HSV, I don't fear her result being wrong. I more so worry that my results could be wrong. I had additional labs doing on 9/9, that were negative. No specific amount, just comes back as negative. 

2.) When you say most are on the shaft, is that true for recurrent as well? Are recurrent outbreaks more often one bump or more? I have never had anything on my penis and any time I have been paranoid, I am hyper aware and checking. 

3.) I definitely know what you mean. Would Hydrocortisone have made herpes worse? It has given me some relief. Would it be worthwhile to still go to Urgent Care? 

4.) I've had chemotherapy five plus years ago - at times with chemo I was given Valtrex to head off shingles. If I had herpes, what is the likelihood I would have found out during chemo, even with Valtrex?
Terri Warren, RN, Nurse Practitioner
Terri Warren, RN, Nurse Practitioner
50 months ago
If you were both clothed, I have zero - and I mean ZERO - concern about herpes transmission.  No, the moisture that might have been there does not wick the virus through onto skin.
It is true for both new and recurrent disease that HSV 1 would show up most often on the shaft of the penis.  And I would say most often recurrences are more than one lesion.
Cortisone would like make herpes worse as it takes away the cellular immune response which is necessary to combat the virus.  I do not personally think going to urgent care would be helpful at all and may be harmful due to the confusion caused by picking at the lesion
It's hard to say what effect Valtrex might have had on a herpes presentation.  So you are worried now that all along you might have been infected and it just didn't who up - not just this incident?

Terri
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50 months ago
That is correct, I am more terrified that I have always had it. I don't think it was possible to get it from the strip club, that has just opened myself back up to searching the internet. And when doing that, and having something like this, it allows you to obsess. With my wife being pregnant, it is making the fear much worse. I know I made it worse by popping it and probably by tweezing hair around the area, so kicking myself there. Re: chemo, I was perhaps incorrectly, assuming my immune system would not have been able to prevent an outbreak.

When people have mild or less typical outbreaks, are they still painful? Do the sores always open? Outside of trying to pop it, there hasn't really been pain, more I'm hopeful it was an infected hair follicle. I'm just at a loss here. 
50 months ago
Sorry, meant to tack this on. Is the Western Blot still considered 99%+? May need to have my provider try and get this.
Terri Warren, RN, Nurse Practitioner
Terri Warren, RN, Nurse Practitioner
50 months ago
Mild outbreaks can also be painful, yes, they aren't always.  And yes, the sores mostly do open, but you might not notice that phase of the outbreak. 
Chemo without Valtrex might have elicited an outbreak, but the Valtrex could have kept things under control. 
Honestly, the odds are so against you being infected and this being a herpes outbreak.  I can't offer you 100% assurance, true, and you may need the 99% sensitive western blot to get the certainty that you need.  I'm so sorry this is causing you such angst.

Terri
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