[Question #1198] Follow-up to #1182

84 months ago
Brief recap:

 -I noticed the red bump on the bottom of my scrotum (close to my perineum) on Monday night. I plucked a few hairs in the area, hoping/praying that was the cause.
-Tuesday morning, I stupidly popped it in the shower and felt it pop under the skin, which was the first time I felt pain associated with it. It not surprisingly became swollen, which Terri said would have made it difficult to have looked at now. Which I understand and agree with. And regret. 
-Starting Tuesday, I have been taking Ibuprofen and putting Hydrocortisone on it. 
-On Wednesday, my Nurse Practitioner also prescribed Sulfamethoxazole/Trimethoprim Ds 800-160 and reiterated that since I popped it, all she would likely get on a swab would be staph. 
-Over the last few days, it is slowly going down in size, though still somewhat firm to the touch. It has never opened up, never become more than one "bump".

I have been with my wife (both of us exclusive 100%) for seven years. Prior to that we were both sexually active with multiple partners, but each of us have had negative IgG (she is + for HSV1, no biggie) tests. Her in 2012 and me as recent as last week. I'm having difficulty shaking the HSV scare, knowing that the IgG tests are 93-95% reliable and on some sites like Honeycomb, etc., there seem to be many people that have negative tests, yet swab positive. This is fueling my anxiety and obsessive thinking, along with this questionable spot on my scrotum. Any insight or opinion would be highly valued. Many thanks.

Edward W. Hook M.D.
84 months ago

Good day.  Today I will be answering your questions and trying, like Terri, to help you move forward.  I think you are being paranoid and perhaps increasing your anxiety with a bit of guilt and shame related to your decision to receive a lap dance.  You can ask "what if" and "could it be" questions without end but the bottom line is that you were clothed during your lap dance and HSV is NEVER passed through clothing.  this is the case even when the clothing is wet with genital secretions- never.  Thus, as Terri has already said, there is ZERO chance that the lesion you discovered we HSV acquired through a lap dance.  Zero!

In addition, as Terri has told you, the majority of herpes lesions in men occur on the penile shaft and rarely at the base of the scrotum.  In contrast, it is quite common for there to be benign cysts and folliculitis in this region.  Your squeezing may have led to a minor secondary infection. 

I urge you to stop worrying about test performance in a situation when there was no reason for being tested in the first place.  I do not mean to be harsh but you need to get a grip on yourself, address your lap dance related guilt and figure out how to move forward.  I hope you find my comments helpful.  EWH

84 months ago
Dr. Hook:

Many thanks and I completely understand the tough love. Just to be clear, as I think my stream of thought was not allowing me to accurately articulate my concerns. I do NOT think I contracted something during the lap dance, though you are correct about guilt being associated there. Something I've worked on and continue to do so.

My concern is that due to my college sex life, might I have never have had an outbreak and my tests not have picked them up. It just seems to be a dual anxiety where I have a concern regarding herpes AND then a scrotal bump that concerns me. 

Logically, I am trying to think that I have never had any lesion on my penis and negative tests. 

1.)Are recurrent outbreaks on the scrotum rare as well? Would these typically show up in more than one lesion? Outside of me (stupidly) popping it, there has not been pain associated with this. 

2.) It has never opened and has been slowly going down in size. I'm assuming what I am doing (Ibuprofen, Hydrocortisone and Antibiotic) would not cause HSV to begin to resolve. Would that be correct? Also, I have seen where the prevailing thought is that Hydrocortisone would likely make HSV worse.

3.) I had chemotherapy and a Stem Cell Transplant. My assumption is I would have likely found out about this during that time. I was on Valtrex at times to keep shingles at bay (though I did get shingles). Is that logical thinking?

4.) How long on average would a recurrent outbreak be? Monday will be one week, though I know I aggravated the bump.

Many thanks, I hope it is clear that I am trying to be logical here and not just being driven by anxiety. Have a good Saturday.
Edward W. Hook M.D.
84 months ago

Your concerns about some sort of long standing HSV infection which has been missed by the testing you have had so far is even more illogical than any concerns about getting HSV through clothing.  The reason we have tests is to inform and guide decision making.  You now have negative tests, no recent exposures, and no symptoms that sound the least bit like HSV. Your time would be better spent worrying about being struck by lightening.  As for your specific questions:

1.  Correct, scrotal recurrences are, if anything, even rarer than initial scrotal herpes.  When recurrences occur there are typically multiple lesions.  As both Terri and I have told you, the lesion you are focused on in NO WAY suggests HSV.

2.  Sigh the area where you traumatized yourself in manipulating what was likely a benign cyst is healing.  Herpes would resolve on its own but THIS IS NOT HERPES.

3.  If you had HSV, you most likely would have had an outbreak during your transplant and chemotherapy-induced immunosuppression.  

4.  Typical recurrences heal in 3-5 days.

I hope this helps.  You really need to get beyond these concerns.  EWH