Possibility of herpes

[NOLARocks]

Doctors- thank you for providing this service.  As a back story that will help you in answering my question, I have been celibate for five plus years ( I am dating a girl who is a virgin).  I have been tested for all STD's and in all cases the results have come back as negative.  I woke up Friday morning with what appeared like a pimple or blister that I had scratched while I was sleeping right below my waistline, right above my butt crack, for lack of a better term.  It is about the size of a dime and is a single lesion. As of Sunday there was no pain associates with it- only when it is being pressed on while I sit as it is a open sore.   I have never had herpes symptoms before.
What are the chances this is herpes?  As stated earlier in the post all STD tests have been negative including the Herpselect test.  I have actually taken the test twice roughly two and three years ago, respectively.  The time between my last sexual encounter and the testing should be than enough time to create IGg antibodies from everything I have read.  I know the herpselect is highly specific, so if not herpes, what else could it be.  Do you recommend and additional testing such as WB, or are two negative results pretty definitive?  Could it be shingles?

Thanks!

[H. Hunter Handsfield, M.D.]

The details you are asking about will make no difference in my opinion or advice.  My replies above give several reasons why herpes isn't a likely cause; the appearance of the rash is a minor part of it.

You're never going to get a clear answer online, either on this forum or any other site.  See a health professional about it.

[NOLARocks]

I probably know your answer, but the lesion has been very itchy today- normal healing process, or something to worry about?

[H. Hunter Handsfield, M.D.]

No, this makes no difference.  But a single lesion usually would be 2-3 mm, even less.

[NOLARocks]

I don't think it makes a difference, but I probably overstated te size.  It is probably half a centimeter by three fourths of a centimeter.  How big is a typical herpes lesion?

[H. Hunter Handsfield, M.D.]

It is exceedingly unlikely this is herpes.  First, the location is atypical.  While genital herpes lesions can occur anywhere from waist to upper thighs (the "boxer shorts" area), the large majority are on the genitals.  Second, with no previous such lesions, a new HSV outbreak at this time would be unusual.  Third, a dime-sized lesion isn't suggestive of herpes, which would either be smaller -- or might appear as a cluster of several blister-like lesions.  Fourth, there are many non-STD skin conditions that could be responsible; herpes would be less common than most of them.  Beyond that, I cannot venture a guess at a specific cause.  Finally, your negative HerpeSelect blood tests show you aren't infected -- and since you haven't had any sexual exposures for 5 years, it can't be a new HSV infeciton.

I recommend you do nothing.  Don't manipulate the lesion and let it heal.  If it doesn't resolve on its own in a week or so, see a doctor about it.  But I see no reason to be concerned about herpes.

Regards--  HHH, MD