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Small sore itchy lesion earlier and now recurrent red marks and bumps on penis

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when I was 16 I had a small sore itchy lesion on the tip of my penis that leaked a large amount of fluid. I seen 2 doctors that said it was not herpes but thought it was a yeast infection that had gotten infected. I was told to put Neosporin on it and it seemed to get worse later finding I was allergic to Neosporin. After a week or so of it not getting better they sent me to a dermatologist that looked at it quickly and said yes it was probably herpes due to some "petal" shape on the skin and went away a couple of weeks later. I am now 33 and from time to time ever since I have gotten small red marks, sometimes bumps that some times feel almost like chaffed skin and sometimes like nothing at all.

I have never had an actual sore since the time I was 16 but just the small red bumps. they last usually for a day to 5 days. I have since been to 3 different doctors to show them the bumps and they have all said it was from sweating too much or general irritation. I have shown my main doctor several times and each time this is what he has said as well. the last time in april I went to another doctor and he said it didn't look like or sound like herpes but ordered a blood test that would show what type if any of herpes I had because there was nothing to swab (there is never anything to swab is what I am told). He also order a large range of other STDs and they all came back negative. Now this time I have had these bumps since the 7th of October. On the 8th I had a chaffed almost burning sensation that was gone the next day and they were pretty much gone in 5 days but then came back in the exact same spot 2 days later and went away again. They were gone until my wife and I had sex and had reappeared right after having sex and were gone in the morning only to come back a couple of days later. That was 6 days ago they have been just barely visible for the past 3 days and yesterday the chaffed feeling was back and is gone today. I am very concerned that my wife may get it since I got the bumps right after we had sex and I am very worried that she will contract this orally since we did practice oral sex that night. My question is how accurate is the blood test I received and does this in your opinion sound like herpes? This is causing me such anxiety that it is starting to effect every minute of my life. I am losing sleep, having panic attacks and can not focus on anything because it is all I think about anymore. I am so afraid to give my wife or family something somehow that I am going crazy.

Category: Family Physician-GP

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Category: HIV- AIDS Specialist
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Thanks for your query at

I can understand your difficulty coping with this frustrating situation. It seems like you have had an initial herpes infection (that was not properly treated with antiviral meds) when you were younger and now the dormant virus is causing you flare ups of the lesions on your penis. The best thing you can do is to avoid triggers that cause flare-ups. It is possible that heat and irritation can contribute to the recurrent lesions which are causing you much anxiety.

Here is what I suggest:

1. Do your best to avoid such triggers as heat and irritation by wearing loose underwear and clothing and allowing free movement and air to your genitals.
2. Sex can be a reason for flare ups as the friction can irritate the penis. During sex, use an organic water-based lubricant to ease the irritation and reduce outbreaks.
3. To reduce outbreaks and also decrease the chance of spreading infection to your partner, consider taking an oral antiviral pill everyday. Although this may be inconvenient (to take the pill everyday), it comes with minimal side effects and it has been proven to reduce transmission to partners and you have an opportunity to protect your wife as well.
4. Aciclovir is an older antiviral drug that is known to work well, and valacyclovir is a newer drug that when taken daily has been known to reduce the recurrence of outbreaks in infected individuals.
5. Make an appointment with a local infectious disease specialist or general practitioner and get your wife tested as well to determine whether or not she has been infected already. She may benefit from antiviral medication as well.

It is quite possible that you received a false negative report on your blood tests. Your history and the symptoms you are describing mimic herpes and this is the most likely diagnosis. Re-do the blood tests (during an outbreak if possible) as these are the times when the viral load is more detectable. If positive, discuss with your doctor about daily antiviral therapy. Other possibilities for your condition could be contact dermatitis from something that you are in contact with and allergic to, such as soap, lotion, condoms (if used), lubricants, and clothing. Take a mental survey of what might suspected allergens in your daily activity and consider what to eliminate if necessary.

Hope this helps. Take care and please ask any follow up questions, if any.

Patient replied :

what test do you recommend? I took the blood test that determines what type 1 or 2 I have if that is not reliable what else is there? At this point I have no faith in the tests if they are so unreliable I also have little faith in a visible diagnosis since I have been to 4 doctors now that have all basically told me not to worry about it that it was just irritation from sweating and rubbing. Is there an 100% definitive test? I have asked for swab tests but I am always told that there is nothing to actually swab since I do not get sores but just little red bumps or spots. Also I am very worried about this showing up on mine or my wife's mouth due to bumps showing up right after we had oral sex. Are we still able to kiss our will that infect them as well or is there some sort of vaccine for them? They are 3 and 5. I am sorry for so many questions but I have not be able to find a dr that took any of my concerns seriously enough to give me straight answers.

I understand your concerns and I will try my best to answer all your questions and help you come to a solution.

There is a very sensitive and specific test for the herpes simplex virus that is not normally done on skin lesions. This involves molecular testing with polymerase chain reaction (PCR) for genetic material of virus in the lesions. This test can not only tell if you have herpes, but it can also tell the difference between type 1 and 2 (although most genital lesions are type 2). The samples should be taken during outbreaks for increased chances of detection if present. If the test is negative, you can be assured that your lesions are not herpes related.

Having said that, you have mentioned that you have already taken the blood test, which was negative. Furthermore, your doctors have relayed that there is nothing to swab and the lesions do not resemble that of typical herpes lesions. You may want to consider the possibility of another diagnosis. You mentioned that you were screened for other STD's which came back negative. There is a possibility that either there is another infection, such as candidiasis (judging from the lesions you have described), or it could be an inflammatory or non-infectious cause such as lichen nitidus, hirsuties papillaris gentalis, or Fordyces spots.

In the latter, the non-infectious causes, the lesions are usually self-limited and do not require any treatment. Fordyces spots are normal and present in 80% of the male population and are completely harmless. These would not spread to sexual partners or anyone through kissing, to answer your question. If you are not experiencing any other symptoms such as itching, inflammation, redness, painful sex, fever, or spread of lesions to other areas of the body or other persons (thus far) ~ then most likely it is not an infectious cause. This may be the reason why the physicians who examined your lesions did not treat you for any infection with antibiotics or further treatment. Here is what I suggest:

Make an appointment with a reputed dermatologist. If you haven't already done so, get tested for other possible infections of the penis, such as candidiasis (penile thrush), molluscum contagiosum, human papillomavirus. Once infection is ruled out, you can be confident that the lesions are not contagious. You may require a biopsy of the lesions to determine an accurate diagnosis.
Make an appointment with an allergy specialist as well. Do pin prick allergy testing to determine if you are allergic to something specific causing you the rash to flare up on your penis.

In the meantime, hydrocortisone creams can help you with the outbreaks in reducing the bumps and speeding recovery. Use as needed, only during outbreaks.
As far as a vaccine is concerned, it is difficult to tell without an accurate diagnosis, and there aren't vaccines available for most of the above mentioned conditions.

I hope this helps. Take care

Dr. Jaydeep Tripathy
Category: HIV- AIDS Specialist
MBBS from Sri Ramachandra University in December 2011
M.Med (Family Medicine) - TNMGR University, Chennai
MBA-MPH in Public Health in March 2016, SRM University
Finished AFIH in March 2016, SRM University
MRCP ( UK ), Internal Medicine, Royal College of Physicians, June 2016
Fellowship in Diabetology from Martin Luther University in January 2017

Currently Resident Physician, in MD Radiodiagnosis - Kamakshi Memorial Hospital, Chennai
Dr. Jaydeep Tripathy and 4 other Medical Specialists are ready to help you

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