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Is this Dermatitis, Eczema, or Herpes?

I've been reading this forum for a while, and have seen a doctor, but I am still unsure what to make of my symptoms.

I had a protected vaginal sex using lubricated condoms with a woman that I would consider pretty promiscuous on May 18. The next day I noticed some slight redness on the right side in the pubic region, right in the skin fold above my genitals. It is like a red line that runs along the fold in the skin and slightly reaches onto my genitals. It felt quite irritated and sometimes hurt a bit, but never itched, nor did it ever progress to blisters, ulcers, or open sores. After trying to moisturize it for a couple weeks, I went to an STD clinic to get it looked at, though it had grown somewhat faded by this point. The doctor examined it thoroughly, and due to my lack of any other symptoms, as well as my history of eczema in other sensitive areas in the past, concluded that it was just eczema or dermatitis. She recommended that I use a 1% steroid hydro cortisone on it that I had been prescribed for eczema in the past. Due to the timing of it appearing directly after the sexual encounter, I was/am skeptical and believe it could be an atypical case of herpes.

I continued to use the cream and it went away shortly after. I forgot about it entirely until last week, when an identical red line of irritation reappeared in the same area. It has been there for 4 - 5 days now despite my continued reuse of the steroid cream on it. A couple times I have woken up in the middle of the night to the area hurting quite badly, but no redness or sore being present in the genital fold area that is in pain.

It is still present now, and I am continuing to treat it with the hydro cortisone, but the timing of the first appearance, and recurrence and pain is really making me worried. Could this be a mild atypical case of herpes? Or does this sound like a different recurring skin condition? I am planning on going to the clinic to get it looked at again, but I am worried that the difficulty in being able to see it is going to make the doctor unlikely to perform any testing, and the long wait will not be worth it.
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207091 tn?1337709493
Herpes symptoms (or any other STD) wouldn't appear that quickly. It would take 2 days at the barest minimum.

Since you have a history of eczema, it could indeed be that or another form of dermatitis. It could also be a fungal infection, but the timing would be really coincidental.

If you are going to get it looked at again, stop using the cream for at least 24 hrs. That could cause problems with any skin testing they do.

Do you shave or trim the area? Could it be folliculitis (infected hair follicles)? I'd think that since it's responding to the hydrocortisone, it's inflammatory in nature, and not bacterial, but sometimes it helps to rule things out.

Honestly, it sounds more like eczema or dermatitis, or a fungal infection of some kind. The pain could be because it's in a fold, and it may be chafing.
Helpful - 0
Thank you for taking the time to reply, I really appreciate it.

I hadn't shaved the region before that day when I noticed the sensation and was trying to get a better look. It doesn't really look like folliculitis; there isn't anything that resembles pimples and there are no raised areas of skin. It is essentially a half inch long line in the skin fold that is difficult to see sometimes, but becomes more visible when it is red. It doesn't ever open into something that looks like a wound, or past what I would call an abrasion, but the irritated/sometimes painful sensation is too strong to ignore.

It did show up within 24 hours of activity, which makes possibility of STD less likely, but the timing of it occurring directly after the encounter makes it hard for me to think that wasn't the cause. Seeing some stories and examples of people who mention "paper-cut like" lesions are what are making me worried, as well as the recurrence in the same area. I know other skin conditions can show up in the same spot as well but the fact that it is in a spot the condom didn't cover is causing me a lot of concern. I've also heard pain in the area without visible sores is a potential symptom as well.

Thank you again for reading this. Your work on this site is highly appreciated and is a very informative resource.
207091 tn?1337709493
The timing is really something to consider - it's too soon for any STD to appear, but not for an allergic reaction. If you aren't still being exposed to whatever the allergen is, I'd expect that to clear up, but perhaps you used something then, then didn't, and used it again when the symptoms reappeared?

Think of everything you did during and after - did you wash after? Use a different soap?

I used to work at an STD clinic, and a nurse practitioner I worked with used to tell patients with fungal infections to use the creams for 2 weeks after all symptoms disappeared. He felt that was the only way to really cure it. Whatever this is, maybe you just needed to use the cream longer.

Even if the woman had herpes - and you have no idea if that's true - the chances of you getting it from a one-time, protected encounter are slim if she didn't have an outbreak.

Studies have been done on hsv2 and long-term relationships. For female to male transmission, over the course of a year, assuming sex 2-3x a week:

Only avoiding sex during an outbreak - 4-5%

Adding condoms OR daily suppression - 2-3%

Adding condoms AND daily suppression - 1-2%

This means that if you were in a relationship with her, you'd have about a 4-5% chance of getting it from her over the course of a year if all you did was avoid sex during outbreaks, if she has herpes.

This comes out to about 1 in 1000 sex episodes. You used condoms, which reduces that.

Maybe it's time to see your dermatologist. It's really unlikely to be herpes. At some point, I'd imagine you'd have blisters, what with all the other symptoms you've had, and you've not had those.

Helpful - 0
Thank you for the reassurance.

I did shower right afterwards, but I didn't use any soap or anything I hadn't already used before. The area hasn't come into contact with any material or lubricant like that since, but I do exercise a lot and it's been a hot summer so it could have gotten triggered by sweat. The doctor did instruct me to use the cream at least 10 days after it goes away to make sure it stays gone, which I stupidly didn't follow because I figured once the symptoms had disappeared it wasn't worth worrying about anymore. I've read that a steroid cream makes herpes sores worse, so would the fact that it helps likely be evidence that this isn't herpes as well?

I should have mentioned in my initial comment that I noticed she had some rash looking spots on her buttocks after intercourse, but my skin never came into contact with this area. When I asked about it she assured me she had seen a doctor and it wasn't anything serious, but it is still causing me a lot of worry as well.

Resolving this issue is just difficult because the doctor said that there isn't anything in the area that is swabbable for testing, and I live in a country that doesn't like to conduct blood testing. In the meantime the occasional pain during this recurrence is really driving my anxiety up the wall, so thank you again for all of the advice. I will likely book an appointment to get the skin examined if it persists for much longer.
That's true - herpes doesn't respond well at all to steroidal screams.

Her rash was nothing serious - could have been yeast or another fungal infection and that's causing your symptoms. Those would respond well to a steroidal cream.

You can use the cream again and see if it helps, this time using it for 10 days.

It could also easily be something triggered by sweat. It's summer, it's hot, you're exercising. That explanation makes the most sense.

I'm sorry you live in a country that doesn't like the blood tests (UK or Canada, most likely). There's some decent reasoning behind it, though - there are false positives, and it can put you in a circle of hell trying to figure it all out after that happens. It does help ease minds, though, when it comes back negative.

Hang in there and keep me posted.

Thank you so much for following up with all of this.

The redness seems to being going away. It is very difficult to see 90% of the time anyway, so I think the cream is likely helping there. However the localized pain in the area has remained pretty constant the last few days. There are no physical signs of anything, just a steady pain in the right side of the pubic region just above the genitals that sometimes feels like it shifts down to my right testicle. It's hard not to google things and look around on different posts here in the meantime, and a lot of what I'm finding has me worried about the possibility of an STD. The absence of anything testable on the skin means I will likely need to find a clinic that is willing to do a blood test to confirm it's nothing serious.

Do you think that would be a good idea, or is the possibility of false positives not worth it? I know a lot of people detect sensations that may be just be from anxiety, but this pain is definitely real and has been present in varying degrees for about 6 days now.
If you are in the UK or Canada, it will be very hard to find anyone to do the blood test. If you're in Canada, and close to the states, and want to take the time and spend the money on this, you can get a test done here.

I just found this site - https://www.letsgetchecked.com/ca/en/home-herpes-test/

I have no idea if they are reliable or not. The info they give about who should test is suspect (sharing a needle with someone who has herpes is NOT a risk, and you don't need to be fasting to take a herpes test), but that doesn't matter if the testing is accurate. It's up to you if you want to risk it, though. I know nothing about this company, so I can't vouch for them.

Oh and they're in the UK if you're there - https://www.letsgetchecked.com/gb/en/home-herpes-test/

You can check their locations on the site if you are in a different country.
Thank you for the resource, and for all of the help, I really don't have anyone else to talk to about this so I really appreciate it. Unfortunately I don't really have the time or money to follow through with that right now, but I may resort to it if it's my only option left.

I have a doctor's appointment but I couldn't get in until this upcoming Monday, so who knows if this symptom will even be showing by then. The redness and sort of irritated looking skin gets better and worse throughout the day, but there is a sensation that sometimes escalates to pain that is pretty much always present. I'm getting pretty anxious with all of this in the meantime, I really don't know what other explanation there could be. The timing of its initial appearance and disappearance, and now this recurrence, is making me think that this is herpes. I've read that it can present with just red irritated skin and no blisters as well, but there's so much conflicting information out there that it's hard to make sense of it.
Herpes symptoms, even if it were just redness, which is really not likely to be herpes, wouldn't get better and worse throughout the day. The symptoms would be pretty constant.

The timing is suspect, unless it's a persistent fungal infection. Have you been using the cream?
Yes, I've been using it twice a day.

It seemed to be almost completely gone this morning but is showing some visibility again now. I'm not sure what to make of that. It's been 2 weeks since this reappeared so if it goes away in the next few days would that be in the timeline of a normal herpes recurrence? I've been treating it daily with the cream, so I'm not sure if it is healing and going away because of that or because that's the normal cycle for the virus.

Both times this has appeared I have checked thoroughly every day and there have never been any bumps, lesions, or blisters, or any itching really. It has just kind of been a sore spot of red irritated skin. It looks like it will likely clear up by my doctor's appointment, but I took some pictures of it when it was present a few days ago and again when it looked like it was gone this morning.
Again, if it were herpes, it wouldn't be responding well to a steroidal cream. Herpes hates those.

A herpes recurrence typically clears up within a week or so, give or take, without antiviral treatment. Two weeks would be a really long time for herpes, but not so much for a fungal infection, eczema, dermatitis, etc.

Thank you for your help with this previously. The situation is still concerning me, here are some updates since I last posted:

-doctor in September was confused when visually examining area, but concluded that it was likely dermatitis and prescribed more steroid cream

-I continued to treat it and it went away after a couple more weeks, not sure if cream had anything to do with it or if it disappeared on its own

-identical irritation came back in late November, I booked an appointment and saw a different doctor in early Dec

-another visual examination, she thought it was just dermatitis as well. When I explained full context and asked about any possibility of STD's she said the same as first doctor, none match the description but the instance and recurrence is similar to herpes, though the presentation does not look like it. She said she;s sure it isn't HSV and that I do not need to worry about spreading it if I am having encounters with new partners

-she prescribed a larger container of the steroid cream, I continued to use it through Dec and into January

-it has felt painful through these past 6 - 8 weeks, some days much more than others, changing in appearance from very red to not visible at all

-back in Dec post-doctor visit, I had quite a bit of pain in my hip to the side that the irritation was on as well, making me worried

-it is still present and quite red and painful today, completely different from other instances of eczema/dermatitis that I have had in the area in the past. Those spots have faded relatively quickly after steroid treatment and sometimes return slightly but never with the high visibility or pain like this does

After all of this I am still left confused and worried, and feel like I have no real way of finding an answer with 100% certainty. I have had 3 doctors tell me now that it isn't herpes, but haven't really received a confident differential diagnosis or any form of testing either. It's very difficult to tell if the creams are doing anything or if the spot is just fading on its own. Since its initial appearance, it has recurred 3 times in about a 6 month span. This current presence has been there for about 6 - 8 weeks now, despite my daily use of medication on it. It's never appeared as a typical and obvious HSV sore, but I have seen a lot of similar stories of painful redness/irritation being the only presenting symptom and it turning out to be herpes.

All of this is really stressing me out. Any thoughts or advice you'd have on this situation would be greatly appreciated. Thank you
I agree totally with your doctors. Herpes wouldn't last for 6-8 weeks - it would last about a week, and then go away.

The initial timing of the symptoms also suggests it's not herpes.

Have any of the doctors been dermatologists? If not, it's time to see one. Maybe they can culture or biopsy it and see exactly what it is.

I don't know where you are seeing the stories about having redness/irritation and it being herpes, but not everything you read on the internet is true. Also, people can have herpes, and also have eczema, dermatitis, allergic reactions, etc. Perhaps they tested positive for herpes, and also had something else.

Yes I think you are right as well. No dermatologists yet, but I should see one if this current phase continues. I know an outbreak wouldn't last nearly this long, I suppose I was just worried that the steroid cream was making it last longer if it was herpes. It's non-similarity to the other cases of skin issues I've had down there made me nervous as well.

Most of my fear comes from posts like this one:

Anyway, thank you for all of the help. I'll post again if any major changes happen or if I actually get a test done.
That person has post-herpectic neuralgia, maybe, which is rare. He also tested positive for herpes, which you don't yet know if you have.

3 docs have said yours is dermatitis. The timing doesn't suggest herpes. I'd get it cultured or biopsied before worrying about PHN, and if you can, get an IgG from the place I linked above. If you test negative on the IgG, you can move on to find something that works for what you do have.
I've still been treating the area with the cream. It does seem to gradually get better, but then will eventually worsen and the pain and appearance will return, and doesn't seem to go away completely.

This past Friday I saw the same doctor from December. She examined the area again, but since it wasn't flaring up at that moment she just told me there isn't anything there and just figures this is entirely anxiety driven. I'm not going to deny that there is some anxiety in this situation, but I know for sure that this rash and pain is very real, and almost definitely wouldn't be present if the sexual encounter never occurred. I asked about a referral to a dermatologist but she refused because there "wasn't anything there." It's been a few days and it has reappeared again, but I can't just drop everything and get to a walk-in every time this happens.

I'm really not the kind of person to make up symptoms, and I find it strange to think that someone would book doctor appointments and go out of their way to get their genitals examined repeatedly if the problems were entirely imaginary. I asked if a blood test would be possible in order to completely rule out herpes and move on, but she claimed it wouldn't be effective because "almost everyone has contracted herpes at some point in their life so a positive result wouldn't give an explanation for this." She's clearly conflating type I oral and type II genital herpes so I am starting to question her knowledge on the topic entirely.

I'm just perplexed at how little medical help I can get in this situation. It's widely recognized that herpes manifests differently in people, with a lot of people not getting any symptoms at all. So I'm not entirely sure why blisters are an absolute necessity to consider it a possibility when 1. this issue was caused by a sexual encounter and is appearing in the genital region 2. it has disappeared and recurred multiple times within a 6 month window 3. other symptoms like the random deep shooting hip pain are occurring simultaneously.

Even if this isn't herpes, which I'm aware is definitely a possibility, I'm just at a loss. The constant pain is really maddening, and it just makes me wish the encounter never happened and that things were completely normal down there. I'm tired of waking up every morning to the same area hurting. The best the doctor could do for me is refer me for an x-ray for the hip pain and tell me to keep using the cream.
Sigh. She's clearly not aware of type specific blood tests. That's a common misconception, and one that countries like the UK and Canada seem really eager to hold on to. If you want to push it, here's some info on it -


Again, I don't think you have herpes, but it would at least rule it out for you and let you move on from it. Can you go to one of the sites I linked and get it done yourself? Or if you're in Canada, are you close enough to the border to go somewhere and get it done? I think if you can, it's time to make that happen somehow.

I don't think anyone is saying that you are making up the symptoms. Clearly, you've had a rash - that's visible. Can't make that up. You could have dermatitis or a fungal infection (or both) and a pinched nerve, for example. Or an inflamed disc, or something along those lines.

I know it's frustrating. It's coming up on a year, and you've had little relief from it. Ask to see a dermatologist. And get the blood test, even if you have to take some time and save your money for it.

Hang in there.
I would want more than anything in this situation to just be able to get a type specific blood test or a skin test and get a definitive answer one way or the other. Unfortunately I am in a really bad situation for money at the moment and can't even afford to consider saving for that test, and driving to the United States isn't an option either. My request to see a dermatologist was turned down by the last doctor.

I have stopped using the cream since the last post as it seemed to be starting to do some damage to the skin, and the irritation is still present and painful. The shooting pains from it seem to occur simultaneously with the hip pain, both of these pains are occurring close in proximity to one another as well. The hip pain wasn't an issue until this initial problem started lasting for longer periods, and now it is just as painful as the skin sore.

The problem is that all of these differential diagnoses are technically probable, but there hasn't been a single test to prove anything one way or the other, and the steroid cream seems to only be providing temporary to no relief at this point. With how coincidental things would have to be in order for the other explanations to be the case, my mind constantly reverts back to thinking this is herpes. The recurring skin sore and joint/nerve pain all occurring after a risky sexual encounter just seems to coincidental to ignore that possibility.

Since I'm not getting much support from doctors in this situation, I'm losing a lot of time just to researching these symptoms. If I could just get one doctor that would listen to me and be willing to perform a test or send me to a dermatologist, this entire ordeal would at least be headed towards resolution.

I have a doctor's appointment with my GP this afternoon for a completely unrelated matter. I am seriously considering bringing this up to them and asking for a type specific blood test in the hopes that they will take this more seriously than the others I have seen. At this point it would help psychologically just as much as physically. If it is negative I could at least move on to figuring out better treatment than what I've currently been given.

Thank you so much for your responses and kindness and I apologize for ranting here so frequently. This situation has just been going on for far too long all while I'm in near constant pain from it.
So the good news is that the steroid cream is providing at least temporary relief, right? Herpes hates steroids. It would be making things worse if it were herpes.

If you can't travel to the US - and who would want to right now? - can you do this? https://www.letsgetchecked.com/ca/en/home-herpes-test/

Please know that if you test, there is a decent chance of false positives. If you get a false positive, it could take months - especially if you live in a place that doesn't like blood tests - to unravel that. Just keep that in mind.

I'm so sorry you're in near constant pain. I know, personally, how much that alters your life, and alters you as a person. Please don't hesitate to get counseling if you can. Chronic pain changes everything.

Hi auntiejessie, thank you for helping me with your advice on this in the past. I'm still dealing with the situation now and it doesn't seem to be improving at all, and some other symptoms seem to be appearing as well. At this point it is getting harder to believe this isn't herpes, and I suppose I would just like to hear an outside opinion.

The area at the base of my penis on the right side that has been red, irritated, and painful throughout this ordeal is still persisting, though there still haven't been any blisters or obvious indications of an HSV sore. Sometimes the pain will be overwhelmingly present and there will be no redness or anything visible in the area at all. This pain spot has been present for most of the time since my last post, with at most a few days of relief here and there.

In addition to this, I had a strange numbness and pain in the left half of my butt in April that lasted about a week or two. It was severe enough to make walking painful for a few days, and up until present I still feel twinges of this pain recur for a few minutes. It feels like a nerve pain similar to the hip issue, which still recurs as well. This past week I have been having some consistent lower back pain as well, though that may be more easily explained away with some activities I am doing. I only mention these symptoms because I have seen others bring these up as indicators of herpes, and they are undeniably causing me a significant amount of pain as well.

I haven't been back to a doctor to have it examined since the last time I posted. I have moved recently and need to get set up with a new doctor, and will likely be examined again when I get that in place. I still have the steroid cream that was prescribed and have been using it most days. It seems to have a relieving effect as far as the skin pain goes but it never seems to solve the issue for any extended period of time.

At this point the pain is having a substantial impact on my mental well-being. The constant questioning of what could possibly be going on isn't helping either. I know there isn't much you can do to solve the pain, but is there anything here that would inform you as to what could be happening? I am just getting tired of the pain impacting my life so much at this point, and discouraged with what doctors will be able to tell me, especially if the redness isn't visible on the days that I am examined.
I stand by my thoughts that it isn't herpes. The timing of it all - when symptoms appeared, the duration of them, etc - don't match herpes.

Take a pic of the redness to show the doctor. Every time you get new symptoms, take pics so you'll have them to show the doctors.

The next time you have visible symptoms, go to an urgent care and ask them to culture it. They may not be able to do a biopsy there, but they may be able to determine what is causing this with a culture. See if they can also do a PCR swab (they may not be able to at an urgent care).

Have you tried the place I linked you to for a blood test?

The other possibility to consider is that you have some sort of neurological issue that is causing these issues. If nerves are damaged or inflamed, it can sometimes cause damage or redness to the skin.

You need to follow up with a doctor. It's not herpes, maybe some of it is anxiety, maybe it's something neurological. Whatever it is needs to be addressed. Also, chronic pain changes you - it changes your personality, your brain chemistry. Don't hesitate to seek counseling. It doesn't mean you are making it up - on the contrary, it means you need to find ways to cope with it and protect your mental health.

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