[Question #7190] Lesions on genitals

6 months ago
Hi - I have health anxiety so I have a tendency to freak out and spend hours researching when I have any symptoms. I am a sexually active gay man in my early 30s and a few days ago I had 3 distinct lesions appear on my penis - one on the shaft and 2 on the glans. There were no other symptoms - no fever and no swollen lymph nodes in my groin etc. The lesions started out as small red bumps and then became small whiteheads and then started to heal without any intervention though they are still a little red. They had absolutely no pain or tenderness or itch and they did not at all resemble the blister-like lesions I have seen on the internet. For one they were all separate and they looked exactly like the spots I have gotten on my face, legs and back that is definitely acneic. I had an STI panel for PrEP this week that came back negative for everything, but they do not test for HSV. I have also been considering all other options and a couple things come to mind - I used a KY Duration spray for the first time a couple days prior to the spots appearing and I know one of the ingredients is known to clog pores. It has also been unseasonably hot and humid where I am and I have been exercising outside so have been spending more time in sweat-drenched underwear over the last week or so. Please let me know if you think this sounds like HSV or something else. 
Terri Warren, RN, Nurse Practitioner
Terri Warren, RN, Nurse Practitioner
6 months ago
This does not sound at all like herpes to me.  But I'm just going on what you've told me rather than anything concrete. If you want to know if you have HSV, you'll need to do an antibody test, the best of which is the herpes western blot.  You could start with an IgG test but there are some issues with this test.  If you do it, and share the results with me, I'll help you know if you need to do anything else to confirm the results.  But from what you've told me so far, no this sounds nothing at all like herpes and could be explained by weather and a new lubricant.

Terri
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6 months ago
Thanks so much for the quick response Terri. I'm relieved to hear that - I've had spots like this before on the shaft that have been confirmed to just be pimples, as I have some hair follicles there, but I've never had more than one at a time and never on the glans so that is what had me alarmed. In regards to the test - would this be something I do immediately or do I have to wait a period for accuracy? 
Terri Warren, RN, Nurse Practitioner
Terri Warren, RN, Nurse Practitioner
6 months ago
If you do chose to do the IgG test, you should wait 12 weeks from any concerning sexual encounter for the greatest accuracy.

Terri
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6 months ago
Hi Terri - I felt like I needed a follow-up from you after consulting my primary care physician. I went in to see him and showed him the lesions, he said they were too healed to swab and couldn't conclusively say whether they were herpetic or just pimples/irritation. I asked if I should do the antibody test and he said he wouldn't advise it unless I had a recurrence. I obviously don't want to spread this if it is HSV so I just wanted to give you as detailed a description as possible and see if you stood by your assessment that it doesn't sound like herpes, obviously keeping in mind that it is not a diagnosis from you. 

The first thing I noticed were three distinct red marks on my penis - one on the shaft and 2 on the glans. I obviously became concerned and checked these frequently but I also note that I did not have one single symptom otherwise - my temperature is checked frequently because of Covid and I checked my groin lymph nodes daily. The red spots progressed about 24 hour laters into three acne looking spots - they became raised but with a point and possibly small whiteheads, and definitely looked nothing like blisters and none of them shared a base. The two on the glans were smaller than the one on the shaft and one night after a bath look like they produced sebum. The only complication was that the one on the shaft was scratched on a zipper and scabbed over. Other than that they remained red and raised for a few days and resolved and have left minimal scarring that I believe will disappear - all of this over the course of a week. In addition to this the spots were never once tender or itchy and there were no other unusual sensations in my penis area etc. The sexual encounter before this incident was receptive anal sex so would I not be more likely to have developed something in the anal area anyway?  

Thanks again for all your help - truly appreciate it. 
Terri Warren, RN, Nurse Practitioner
Terri Warren, RN, Nurse Practitioner
6 months ago
While these do not sound herpetic, the one that scabbed is of a little concern to me.  Do you actually specifically recall getting your penis caught in your zipper?
You could Google something called Molluscum contagiosum and see if these bumps look like what you are describing.  They have a white substance inside and are raised.  Take a look.
You don't need a recurrence to do an antibody test but you do need to let enough time go by from possible infection to testing.
Was the receptive anal sex protected or not?  And yes, if this was herpes, you might well have had lesions around the anus but if this is a recurrence, it might be on the penis.  If you have been tested for herpes in the past, then that might be a useful benchmark for you.

Terri
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