Dr. Sushil Kakkar
Dermatology
The following is an actual conversation between an iCliniq user and a doctor that has been reviewed and published as a Premium Q&A.
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Patient's Query
Hello doctor,
I have rash on scrotum with 2 bumps that did not become truly visible until I shaved. Could this be herpes?
Hello,
Welcome to icliniq.com.
I would require a photograph so that I am able to guide you better.
Patient's Query
Thank you doctor,
Here are the pictures of it, does not itch really, it only hurts at times if my boxers get caught and touch it now that I shaved. Looks infected because I guess I scratched it.
Hello, Welcome back to icliniq.com.
I have reviewed the photographs (attachment removed to protect patient identity). There is a single well defined eroded lesion/ulcer. I can see some amount of discharge at the floor of the erosion. The lesion is definitely infected and there is some oozing from the floor. I would not rule out herpes altogether, however, herpes usually presents with multiple grouped lesions/erosions.Therefore, I would suggest a blood test for HSV (IgG as well as IgM) for confirmation. I would suggest a week of oral antibiotic e.g either Cephelexin 500 mg thrice daily or Cefadrocil 500 mg twice daily Or Amoxycillin 500 mg thrice daily for a week. This would take care of the bacterial infection. Topically you may apply an OTC (Over the Counter) antibacterial ointment e.g 2 % Mupirocin ointment, twice daily. Can you elaborate about your sexual history? Are you sexually active? Do you have single or multiple sexual partners? Do you regularly use protection/condom?
Patient's Query
Thank you doctor,
I am sexually active but I had sex a few months back with a person but it was with a condom and I received oral without a condom but she had went and got tested as well as I did and results were negative. Sometimes my boxers ride up and I would scratch and dig it out from time to time. But I did receive oral last week from another woman but I did not use a condom. I feel like it was under my pubic hair already but I could not see it until I shaved. Later that week, I used hair clippers to shave down there which are hot I am not sure if I burned myself or cut a hair bump and made it worse spread and get infected that way. I usually have dry skin so when I put lotion down there I did notice that spot remain dry, so that is why I shaved down there in the first place. It does not itch but it does get irritated now that I have actually cut the pubic hair off and it touches my boxers. I feel that my balls are swollen/smaller but there is no burning, itching or discharge coming from my penis. My balls do not hurt or anything, it is just like my penis is kind of smaller and it is not hanging like it usually does like I still do get an erection when I am jacking or stroking my penis now, of course, it hurts a little because that spot is on my scrotum now that I actually shaved but before I shaved it was like a dry spot and I never noticed it.
Hi, Welcome back to icliniq.com.
As far as I can see from the images, the lesion is right at the base of the penile shaft, which may not have been completely protected with a condom. Therefore herpes at the base of shaft of penis is still possible even with protected sex. Moreover, unprotected oral sex is also a route for herpes. It could very well be just a simple bacterial infection (impetigo) but I would still suggest a repeat test for herpes although herpes as I said before usually presents with multiple erosions. Single erosions, as the case here, can nevertheless arise from coalescing of multiple grouped erosions of herpes. In any case you should start with the oral antibiotics because even if it is herpes, the wound would heal if secondary bacterial infection is taken care of with oral antibiotics. I wonder what exactly was the test result for Herpes (HSV IgG or IgM)? How many days after sexual encounter, you underwent this blood test for Herpes? Herpes may not show up in blood test for at least the initial 7-10 days after a sexual encounter.
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