Sexually Transmitted Diseases/Herpes? Pimple?


Pimple? Herpes?
Pimple? Herpes?  
Pimple? Herpes? #2
Pimple? Herpes? #2  

I frequently get these pimple like formations on my upper lip. They’re always in the same spot (right, the picture shows it in reverse), and seem generally painless (unless I attempt to pop them). They never really last too long, and I usually pop them as opposed to putting medicine on them. Although, I should probably try the medicinal route. Does this look like Herpes? If it responds to acne medicine, would this be indicative of Herpes, as well as a pimple?

Also, I often get an itchy/burning sensation along my penis shaft and groin area. Sometimes I’ll also develop a red patch on my shaft, which will also itch. However, the red patch does not need to be there for the itch. I’ve never noticed any blister formations, but I do have sebaceous cysts and folliculitis. I also have a lot of pubic hair, including some strands on my shaft, and excess skin from my circumcision. I frequently run and tend to be a heavy sweater. For instance, when I come off the treadmill, the cotton underwear I wear is usually drenched. I probably sweat throughout the day as well. Herpes has been on my mind lately as a possible diagnosis, and this has caused the itching and burning to increase, or atleast become more noticeable. Does this sound like Herpes or maybe jock itch? Could the sensations be more psychosomatic? I’ve heard recommendations against blood testing, so is there a way I could “test” if it is jock itch? If not, what blood tests would you recommend, if any?

Sexually, I am into guys, but only oral sex, mutual masturbation, and frottage. My primary care told me this was low risk for herpes, because the virus needs to be “massaged” into the genitals. Is this true?

ANSWER: Hello Barry,
The blister on your lip does indeed look like herpes, especially since they recur in the same general area. I would take acyclovir (Zovirax) or valaciclovir (Valtrex), both of which requiring a prescription.

The itchy, burny sensation on your penis and groin may be due to a skin fungus (jock itch). It does NOT sound like herpes there.  The best test for skin fungi is a swab and microscopic evaluation of a suspension of a solution of the liquid. Yeast have a characteristic appearance under the microscope. No blood tests are available for skin fungi, since these are topical, not blood infections.

Oral herpes from your lip and stache area can indeed be easily spread through oral sex or kissing to another partner. The beard stubble may cause enough irritation to allow herpes virus spread during oral contact. You are indeed at HIGH risk for spreading herpes.

Good luck!

---------- FOLLOW-UP ----------

Dose #2
Dose #2  
Dose #1
Dose #1  

Thank-you so much for the professional opinion. I would like to ask a few follow up questions pertaining to my Herpes infection. I experimented yesterday, after submitting the question to you, and put Tretinoin (I think it’s Retin-A) 0.05 cream for acne on the Herpes blister. I got the cream from my Dermatologist, because I frequently have acne. I had bad acne as a teenager (was on Accutane), but it never quite cleared up and I still get pimples regularly. Regardless, I put the cream on and within hours the blister had shrunk dramatically. I could still see the white head, but it looked very small and dried out. After I took my shower I looked in the mirror and while scrubbing my face the dried out white head must have fallen off, because all I could see was a red patch-like bump. The next morning the blister was healed even more. Now, it looks like a reddish/pink patch. I’ve provided a photo of what the blister looked like earlier. I expect it to heal even more with the next dose of cream.

Sunday night-noticed a red patch above my lips forming a whitehead.
Monday morning-giant white head as seen in the picture.
Monday evening-took the first picture.
Monday evening around 7pm-applied first dose of cream.
Monday night around 11pm-blister greatly diminished.
Tuesday morning around  7am-looks like a patch of red/pink (picture provided after this dose)
Tuesday noon-same patch look but a bit pinker (after third dose of cream)

Is healing like this typical for herpes?

Is it safe to continue using this cream on the blisters? I have friends who have cold sores and there’s takes a lot of time to heal. Mine went so quickly.

I just had blood drawn for a HSV I/II type specific blood test. Not sure if Labcorp uses Captiva or Herpeselect. Is there a difference really?

ANSWER: Hi Again, Barry,
I could be wrong about herpes; I'm essentially doing an "armchair" diagnosis without being able to see you in real life, and without being able to ask you the necessary questions to cinch a diagnosis.

1) Tretinoin is not usually a treatment indicated for herpes. It is designed to treat acne.
2) A white head (follicle plugged with sebum/oil) shouldn't look like what you had.
3) Staph folliculitis might come and go as quickly as you noticed.
4) Herpes generally takes longer than a day or so to come and totally go!! I agree with your friends.
5) Herpes blood tests detect antibody either qualitatively (positive or negative), or quantitively (with a number reflecting the strength of antibody, as a titer. It can be for either type 1 or type 2 or type 1 and 2 together, or type 1 or type 2 together. The best tests available are DNA based tests designed to detect specific viral components, not antibody. Herpes is a skin and nerve virus, not a blood borne virus. I cannot comment about the two Labcorp tests, but all antibody based tests are essentially the same.  They may differ slightly in sensitivity (ability to detect presence of antibody if antibody is actually there) and specificity (ability to NOT detect antibody when it is in fact absent).

Sorry if this is rather complicated!  Apply moist heat with the tretinoin cream and or antibiotic cream. Hopefully, it will not recur.

Good luck!

---------- FOLLOW-UP ----------

QUESTION: I had blood-work completed for my Herpes test yesterday at 3:30pm. To my surprise, the results were ready by 5:30am this morning. I am a bit concerned because I've read where it is discouraged to get a non-specific test. I was ordered the "Herpes Simplex Virus (HSV) Types 1/2, IgG Evaluation With Reflex to Herpes Type 1/2-Specific, IgG" and my results read as followed:

HSV I/II IgG Rflx I-II Type Sp

         Result Flags  Units     Ref interval
HSV I/II IgG    <0.9     N      Index      0.0-0.08

Note: Negative indicates no antibodies detected to either HSV-1 and/or HSV-2. Equivocal may suggest early infection. If clinically appropriate, retest at a later date. Positive indicates antibodies detected to HSV-1 and/or HSV-2.

Please Note:
The date and time of collection was not indicated on the requisition as required by state and federal law. The date of receipt of the specimen was used as the collection date if not supplied.

It was supposed to be a type specific test, but all it says is that I am negative for both. I was told that as long as both are negative then the specific test is not necessary and that I am good to go. Are these results worthless? Do I need to retest or can I relax from my worry?

Hello Again, Barry,
Your tests for IgG which is long term antibody, mean that you have not previously been infected with either strain of herpes. It does not tell you whether you were just infected, or whether the recent episode was positive for herpes. That would have been IgM. The best test as I mentioned before, is a DNA/NAAT test, but this wasn't made available to you. So the recurrent blister on your lip is not related to herpes. That is good!!

Hope this is helpful.

Good luck!

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Mark P. Behar


Almost any question or concern about gay men's health issues, sexually transmitted infections, abnormal Pap smears, anal cytology (anal "Pap smears"), etc. There is no such thing as “d/d free” or “clean” (free of infection), so why do so many of us deceive ourselves into thinking that some people are indeed totally free from a potentially infectious disease, like HIV, herpes, hepatitis, syphilis, chlamydia, warts, gonorrhea, etc., just because they say so? Clinical laboratory tests are not perfect, and having a “negative” or “nonreactive” test does not mean that a person is free from infection. Perhaps at the moment the test was taken, the person was uninfected; or, perhaps, the test wasn’t sensitive enough to detect presence of the infection. There is really no way that anyone can determine that they are truly “disease free,” and there are over a hundred of infectious conditions that can be spread without your knowing anything. Rather than trying to “pre-screen” or “serosort” a potential sex-mate with deceptive questions that are impossible to know by today’s technologies, a wiser option may be to consider everyone infected with something, and either use appropriate protective measures (“safer sex”), or accept the responsibility and consequences of possibly “catching” something from someone who’s hotter than expected (pun intended!). There is much research that supports the contention that an HIV positive person reliably taking HIV medications, and having an undetectable viral load, presents a lower risk for transmission of HIV than people who may think or say they are HIV negative, but are not. Food for thought!


Family Practice PA since 1981; Volunteer Clinician for Brady East STD (BESTD) Clinic, Milwaukee, since 1977; answered STD questions submitted to their web site. Professionally lectured at national and regional Physician Assistant and Nurse Practitioner conferences, and at national gay & lesbian health conferences on topics including HIV/AIDS, herpes, hepatitis, STDs, human papilloma virus (the cause of venereal warts), abnormal Pap smears, gay and lesbian health issues, among others.

Co-Founder, Lesbian, Bisexual, & Gay Physician Assistant Caucus of the American Academy of Physician Assistants, Inc.; American Academy of Physician Assistants; Wisconsin Academy of Physician Assistants; National Co-Chair (2012-16), National Association of Black and White Men Together: A Gay, Multiracial Organization for All People (NABWMT)

Journal of the American Academy of Physician Assistants (JAPA) Q Visions, Quarterly Newsletter of the NABWMT

Bachelor's of Arts, 1972 (University of Wisconsin, Milwaukee, WI) Graduate Credits Experimental Psychology, 1972-75 (Tulane University, New Orleans, LA) Physician Assistant, Bachelor's of Science, 1981 (George Washington University, Washington, DC); Masters in Physician Assistant Studies, 2000 (University of Nebraska Medical Center, Omaha, NE)

Awards and Honors
Colposcopy Recognition Award (CRA), the American Association of Colposcopy and Cervical Pathology; Distinguished Fellow, Clinical Preceptor, American Academy of Physician Assistants; Fellow, Wisconsin Academy of Physician Assistants

Past/Present Clients
Brady East STD Clinic, Milwaukee, WI Milwaukee Health Services, Inc. (Martin Luther King Heritage Health Center), Dept. of Family Medicine and Early Intervention Program for HIV Infected Persons

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