[Question #6643] STI Follow Up

14 months ago
Hello I’m sorry to whoever receives this question as I have returned again to the forum despite being told not to worry. However today I discovered a really concerning new symptom of a possible STI infection. 

Both Terri and Dr. Hook assured me not to worry about herpes however today I noticed a new red pimple on my scrotum. It’s on the area of the scrotum where if I were erect and the skin expanded it would likely be on the base of my penis. 

How likely would it be for the pimple/lesion to be STI related? There is no hair growing out of it. I’m certain it is not an ingrown hair. It’s not painful, but I have had tingling/burning in my butt/waste band area as well as occasionally in my genitals the past two weeks and nerve pain. I’m sorry to return after being told not to worry but this new symptom may change that advice. If whoever reads this can review my previous posts and add this new symptom to the list and consider it again I would greatly appreciate it. 

Are herpes lesions commonly one pimple as opposed to a cluster? Do any STI’s result in these single bumps? Also I have two or three pimples on my butt but they’re not close together they’re also all individual not clustered.  Also my most recent unprotected sexual exposure was six and a half weeks ago. Could this be a second outbreak and I didn’t notice my initial one? It’s very concerning. I have a check up with my dermatologist in 10 days but I’m concerned that’s too far away and it will be too late to be properly examined at that point.  
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
14 months ago
Sorry to see you back.

Initial genital herpes lesions occur almost exclusively at the place(s) where the virus is inoculated, which in turn is almost always sites the receive maximum friction during sex. (The virus must be massaged into the tissues for infection to take hold.) Therefore, the scrotum and groin are is unlikely spots for initial infection. Second, single lesions rarely are herpes. Finally, herpes lesions are not like pimples. A single red bump in that location is a zit, not herpes. And no other STD either. (Herpes lesions are superficial; think of them as being "on" the skin. B y contrast, pimples originate more deeply; think of them as being "in" the skin.)


"Are herpes lesions commonly one pimple as opposed to a cluster?" Rarely single lesions, especially for newly acquired infeciton.

"Do any STI’s result in these single bumps?" A wart or molluscum contagiosum -- but it's much too soon for either of these. And no STD mimics pimples.

"Could this be a second outbreak and I didn’t notice my initial one?" Almost certainly not. For the reasons described, this is not something that suggests herpes. And you were at little or no risk, as discussed in your previous three threads.

"I have a check up with my dermatologist in 10 days...." If the pimple clears up by then, you can skip that appointment.

It seems clear you are obsessed to a pathological extent, perhaps the result of anxiety over a sexual decision you regret. Please do your best to move on without worry.

HHH, MD
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14 months ago
Doctor Handsfield I appreciate your response and apologize if my posts are coming off as paranoid. I’m just really struggling with a combination of symptoms. Since the new year I don’t believe I’ve had a single day without some sort of discomfort below the waste. I’ve had daily nerve pain, itching, burning, and tingling in my back butt genitals thighs legs and feet. A strange abrasion on my penis head, a fungul infection on my thigh, pimple on my scrotum. 

1. Does the six weeks of nerve pain concern you at all? It’s been relatively consistent for at least four weeks. I’ve read in your previous posts that anything that persists this long can’t be herpes as those outbreaks are shorter with absolutely no symptoms in between. But Do you have any theories on what else could be the cause? I know atypical herpes are few and far between but could this be that? 

2. Terri said a blood test may be a good idea. Doctor Hook advised against it as I get cold sores and he stated there is a chance of a false positive. Can you offer your perspective on that issue? 

3. Does herpes or any other STD cause such widespread symptoms below the waste or are they always localized to a particular area? 


I originally attributed these sensations to anxiety but the longer they persist with no visual symptoms of an outbreak of some kind the more I’m sure I am not imagining them.  
I am sorry if I come across as irrational I’m just incredibly frustrated. I haven’t been comfortable in two months. 
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
14 months ago
1,3) No STDs, including herpes, cause "six weeks of nerve pain" (or any other kind of pain -- I'm not convinced your pain is neural in origin). Except for things like fever and headache with a new infection, herpes symptoms are always localized; yours don't suggest herpes or any other STD.

2) I can see HSV testing both ways. The results can be misleading, sometimes resulting in more rather than less uncertainty and anxiety. But usually the results are reliable. Given your oral herpes, you can expect a positive HSV1 result. If HSV2 is negative, as expected, it might help convince you that you don't have genital herpes. 

I am confident about three things in regard to your tingling and other "below the waist" symptoms. First, you are not imagining them and none of we three moderators implied that. Psychologically derived symmptoms are equally real as any others. Second, as just implied, they probably have a psychological/emotional origin, as you originally suspected yourself. Such symptoms usually are not created by emotion, but anxiety, worry, regret, shame and other negative emotions definitely can magnify trivial symptoms or normal body sensations that otherwise would be ignored or not even noticed. Third, your symptoms do not reflect anything serious. Not only are they not herpetic, they are not due to any STD or other infection from the sexual exposure, nor to any important medical condition that will ever cause harm to you or a future sex partner. Once you truly understand this -- emotionally as well as intellectually -- they probably will fade to nothing.

You're obviously intelligent and insightful, and do not "come across as irrational". But those characteristics don't immunize you against these psychological issues. If the problems and your uncertainties continue -- whether or not you have an HSV blood test -- you should consider professional counseling. I suggest it from compassion, not criticism, and definitely not as a challenge to your intellect.


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14 months ago
I appreciate your compassion and understanding. You and your colleagues on this forum provide a great service to fight against a lot of the bad information out the on the internet. I just wish I found you guys before I accessed the misleading symptoms out there online, as I'm sure reading about tingling/burning without lesions no doubt contributed to my anxiety manifesting these symptoms I've been dealing with. It's amazing to me how prevalent bad information is. After reading your posts here and on "Medhelp", I now see that all of the other top herpes searches/forums have no problem posting misleading information. I'm sure it's not surprising to you to hear that I am in counseling for anxiety and depression and hopefully with that I can counteract these symptoms that you all believe are causing these conditions.

I worry that my mind will not rest however until I receive a negative blood test so I think I will pursue that as long as you do not explicitly advise against it. Hopefully with a negative test my mind will rest and that will calm my anxiety and thus eliminate the tingling/burning sensations I have been dealing with. Hopefully then I can go on living my life comfortably and avoid putting myself in this position again. Thank you again for your help, hopefully this will be my last post and this is the start of an improvement. 
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
14 months ago
We're glad to have helped. I especially hope my reassurance that you have nothing serious or dangerous in any way helps you move along. If you have an HSV blood test and would like advice from Terri on its interpretation, I'm sure she would be happy to help. Otherwise, this will have to be your last question on these issues. We don't permit repeated questions on the same topic and this is your fourth. Future ones may be deleted without reply and without refund of the posting fee. ASHA is not keen on getting paid for questions whose answers already have been given or that are obvious from earlier discussions, and repeated answers often prolong anxiety rather than helping relieve it. Finally, such questions have limited educational value for other readers, one of the forum's main goals. Thank you for your understanding.

Best wishes and stay safe.

 

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