Rash on Penis Shaft/Glans

[jeff_chicago]

3 wk ago: received oral sex.  she had a cold sore in her mouth 3 days later. No other sexual contact

7d ago: irregular, erythematous, macular rash on mid-shaft.  Rash is 3cmx2cm.  not vesicular or pustular.  Some pruritus. no fever, no prodromal symptoms.

6d ago: small patch of erythema on glans.  Original rash spread, now papular, but not vesicular or pustular.  Increased pruritus.  Applied 1% hydrocortisone cream, took benadryl, helped itching. rash unchanged.

5d ago: concerned for herpes, present to urgent care for dr's opinion.  Dr says doesn't look like herpes.  He says doesn't look like balanitis or scabies.  Tells me it is likely just skin irritation, but he's not sure, could be atyptical or mild presentation of herpes.  Swabs rash for viral cx and draws blood for hsv-1,2 and RPR.  Rx-acyclovir.  

Blood: neg hsv-1, hsv-2, rpr.  Cx pending.

Now: 5d of acyclovir rash still spreading, albeit slowly.  Pruritus present, although benadryl and 1% hydrocortisone help. Still no pustules or vesicles appreciated.

Even though HSV blood tests neg, I have convinced myself that it is likely a false neg and B-cells haven't had time to ramp up ab production to significant levels.  The fact that I have only had sexual contact with 2 people in my life, both of whom have had no h/o stds and the fact that the acyclovir hasn't cleared up the rash both point away from herpes, but I am not convinced.

Pictures:
1- http://img88.imageshack.us/img88/8744/rash1vc9.jpg
2- http://img81.imageshack.us/img81/7640/rash2de2.jpg
3- http://img81.imageshack.us/img81/4273/rash3er9.jpg
4- http://img81.imageshack.us/img81/6775/rash4pr2.jpg
5- http://img152.imageshack.us/img152/8405/rash5ev1.jpg
6- http://img225.imageshack.us/img225/5038/glanszj7.jpg  (Glans)
7- http://img88.imageshack.us/img88/4048/closeup1wb3.jpg  (Closeup)
8- http://img81.imageshack.us/img81/2686/closeup2ll6.jpg   (Closeup)
9 - http://img134.imageshack.us/img134/1863/glans2il6.jpg  (Glans)

Thanks.

[slacker101]

How's everything going Jeff? Did it turn out to be just irritation or herpes?

[slacker101]

You should really be asking these questions on the STD Board. Doctor Rockoff is awesome but the questions you are asking are more geared toward Doctor Handsfield in the STD Room.

Happy to hear so far you are negative and it seems you probably don't have Herpes so far but definitely keep your fingers crossed. Please keep us updated on your final results. I think the tests should be conducted at the 3 month mark. That's what Doctor Handsfield always tells people.

[jeff_chicago]

Received call today from doctor, the viral cx was neg.  I have completed 7d of acyclovir 400mg tid, rash is healing nicely but still itching.  I am still worried it may be herpes even though culture and hsv titers were negative.  When would you recommend me get additional blood tests to recheck IgM and IgG levels?  3mo? 6mo?

[slacker101]

Hey Jeff, definitely keep us up to date with your blood tests!! Would like to know what the results are.

[Alan Rockoff, MD]

As much as I can tell from your photos, I think it is herpes.  Chances are your sexual contact was incubating the virus before the cold sore became visible.  Acyclovir is the correct drug to be on, but it should still take some time for healing to finish.  Oral herpes is mostly from HSV-1, so future recurrences should be, on average, infrequent, and certainly less severe than this first attack.

Needless to say, I can't be certain.  The culture should tell the tale.  But that's what it looks like.

Good luck.

Dr. Rockoff