Sexually Transmitted Diseases/Herpes?


QUESTION: Hello, hoping you can help me figure out what is going on. I have had a strange rash on my genitals for about a week now. It started out as 2 sebaceous glands turning red and spread to the surrounding area. Within 2-3 days another 6-8 spots had appeared most of them had a hair near or around the area or a large pore. About a week after the initial spot i have had at least 10-15 more of these spots pop up, the recent ones do not have a hair near them and are smaller and redder. It is very hard to tell if they are blisters or not as they are small and spread well apart. They do have a mild aching sensation when touched and a very tiny bit of clear fluid can be squeezed out. However due to all the sebaceous glands in that area i have always been able to get clear fluid if squeezing the area, this also accounts for 99% of the raised bumps in the pictures. The area look redder in the pictures than in real life as well.  My main concern is that is is herpes as it started to occur 16 days after receiving oral sex.  Thanks

ANSWER: Hello Jason,
Yes, herpes is one option, as is folliculitis from a bacterial infection.  The ONLY way to know for sure is to get a herpes NAAT test from a swab of the actual lesion, and a bacterial culture from a swab of the actual lesion-- two different swabs and two different tests. Blood tests can only give you indirect and non-conclusive evidence.  

Go to an STD or urgent care clinic and get checked immediately, before the sores heal!

Good luck!

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

QUESTION: Thank you, i will try to get to the single walk in clinic we have in town tomorrow evening. Even if i am unable to get a swab done i know from past testing that i have never been exposed to hsv1 or 2. I had another blood test done this monday that should come back negative and in 2-3 months i will test again. Hoping to be negative both times but i have a really bad feeling this time. Thanks for you time.

Hi Again, Jason,
Best NOT to get a blood test because they aren't sensitive enough irrespective of the tests your doctor may order.

Here are the blood tests available at most clinics:
Herpes Simplex Virus Type I and II Antibodies, IgG and IgM
Herpes Simplex Virus Type I and II Antibody, IgG
Herpes Simplex Virus Type I and II Antibody, IgM
Herpes Simplex Virus Type I Glycoprotein, IgG
Herpes Simplex Virus Type II Glycoprotein, IgG

IgM is an immediate antibody reaction (after about a month, it may dissipate and not be identifiable); IgG is an antibody that persists for life (once positive always positive).

This is the best test available, and is designed to give an absolute "yes" or "no" as to whether virus is present at the time of the sampling:
Herpes Simplex Virus Types 1 and 2 Nucleic Acid Amplified Test (NAAT)

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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