[Question #2648] Please help - is this HSV or something else?

43 months ago
I am a middle aged, straight, married white male, who, in the past 6 months,  has had protected sex with multiple women. A few times I had brief unprotected oral sex.  I received assurances that my partners had been tested.  I have been tested for the full range of STDs twice during this period, the latest one in June - both negative. In the past month, I have had sex with 2 people outside of marriage.  One was brief covered vaginal and brief unprotected oral.  The other is with the  one person that I have seen on multiple occasions, I actually paid for her to get tested and she was clean except for oral hsv.  I tried to be extra careful with her, although she did once - 2 months ago - provide oral sex for a minute or two.  She also regularly licked and sucked my testicles in the last month. I  noticed a rash on my groin area this week, about where it meets my upper thigh,not on my genitals.  I believe I have had it for about 3 weeks, but am not sure.  Today, the PA at the dermatoligist's was not sure what the rash was.  At first, I think he thought it was herpes, as he asked if the rash started with blisters.  I told him no, but I am not totally certain.  The bumps are in an area that is hard to see and I had not been checking it that often. He did not swab, gave me some cortisone, steroidal cream and said come back in two weeks.  There are a few red patches and what look like a little like the scabs at the end of a herpes outbreak.  I have had itching but no pain or burning.  A few questions:1) What is the likelihood that this is herpes? 2) And how can I be sure whether it is or isn't?3) Could it have come from any of the partners I have had, including a few months back? 4) if the odds are 1 in 10, 000 for my encounters, have I been this unlucky? 5) If I have had unprotected sex with my wife, should I tell her about the risk? 6) If this goes away with the medication, what does that tell me? 7) what else can i do, I am so worried!!
Terri Warren, RN, Nurse Practitioner
Terri Warren, RN, Nurse Practitioner
43 months ago
good morning,
so many men have a rash on the thigh in the groin area, where the leg meets the body.  It is most often fungal and antifungal therapy twice a day for two weeks usually resolves these issues.  I'm surprised as his choice of medicines, but he was there and I wasn't.  Did he do a skin scrapping to look for fungus (yeast) under the microscope while you were there in the office? 
I think this is very unlikely to be herpes.  So your risk appear to be mostly from unprotected brief oral sex.  The risk there for herpes is HSV 1, the common cause of cold sores as you appear to know already.  Have you actually been tested to know that you are not infected?  It should be noted that the IgG test for HSV 1 misses 30% of infections compared to the gold standard western blot and that 56% of the population between 14 and 49 already have HSV 1.  You could do the western blot to find out if you have HSV 1 if your IgG test is negative.  If you do have HSV 1, this rash may or may not BE HSV 1 - it doesn't sound like it to me.  I'm not clear what you should do about your wife in this situation.
BTW, normally steroids applied to herpes lesions make the situation worse, not better, so if you are responding positively to the medicine, that also speaks against this being herpes.

Terri
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