[Question #333] Trying to narrow possible diagnoses

35 months ago
Hello,
I realize there is little you can do, medically speaking, via email but I have myself all twisted in knots trying to figure out what is going on.  I think my first problem is reading too much on the internet without proper medical education or context.  I am trying to narrow possible diagnoses of blisters and pain in my groin.  About a month ago I saw a doctor for a herpes scare.  He diagnosed it as folliculitis on my thigh and an ingrown hair above my penis.  After a sexual encounter (always with protection), the sore that was the in grown hair has never really gotten better.  I am treating it now with mupirocin and after day two it is getting better but has not disappeared yet.  What has me concerned most is a pretty consistent pain at the tip of my penis that has been around for two to three weeks.  Pain might not be the right word, because it is only painful in the sense that it is irritating enough that I am aware of it.  It comes and goes but I guess I would say is more present than not. It is not painful to the touch or contact and the intensity of the pain has not changed.  I have had no sores on my penis, scrotum or upper inner thigh.  I have had no painful urination, erections or ejaculations.  I have had no discharges from my penis. I have had no flu like symptoms.    I am making an appointment to see another physician in the next day or so.   I also plan on having a HSV blood IGG test done at an order-your-own-test lab.  Can you help prepare me for possible diagnoses?  What it could be or what it probably isn't based on what I've give you?  I greatly thank you for your time and consideration.  Regards.
Terri Warren, RN, Nurse Practitioner
Terri Warren, RN, Nurse Practitioner
35 months ago
Hello Ben,
It is very difficult to help people over the internet with a diagnosis and thankfully, you have seen your doctor in person to evaluate your skin issues.  While it is possible for your doctor to misdiagnose someone, I think if there had been any possibility that this was herpes, your doctor would have been swab testing this.  You mention blisters in your post - like water blisters?  Are they grouped or single?  Do you see hairs growing out of them?  Normally herpes would be present with a small group of water blisters.  Is it like that?  You've had this for a month now?  Herpes does not hang around for a month.  And if you had acquired new infection at the sexual encounter, the first infection likely would have shown up on the genitals, not on the thigh, though recurrences can happen on the thigh.  Also, most herpes can be somewhat at least tender to the touch.  Sometimes when a patient presents with a suspected herpes lesions I ask if it is tender and often they say no.  but when I swab test it, THEN it's tender - so it is tender to the touch.  You are not describing that. 
When you test, be sure you have waited 12 weeks for the most accurate result and be sure you do NOT do IgM, only IgG.  From your description, this does not sound like herpes to me, but I of course couldn't say if you have herpes in general.  Please let me know further questions

Terri
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35 months ago
Hi Terri,
Thank you for your answers.  To clarify there were two water blisters, about an inch apart but not near my genitals.  They broke open when drying off after the shower, scabbed over and went away without any pain or leakage. 
I guess the most concerning thing is the pain at the tip of my penis I had mentioned in my original question.  I have not had any discharge or painful urination.  There has been no painful erections or painful ejaculations.  But I have recently noticed a return of the pain a day after masturbating.  Again the pain is not intense it's just annoying and very concerning.  The water blisters I mentioned appeared about two months before the pain started.  Does this sound like it could be urethritis related to HSV? 

Thank you again Terri.

Regards.

Terri Warren, RN, Nurse Practitioner
Terri Warren, RN, Nurse Practitioner
35 months ago
It is possible that the water blisters and the pain are unrelated.  first, I think you need to try to sort out if you have herpes or not.  When will it be the time for testing for you?  12 weeks after a worrisome sexual encounter?  As I mentioned, the constant symptoms just don't sound much like herpes, but the water blisters are concerning to me. 

Terri
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