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Dr. Andrew Rynne

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Is a yellow scabbing and watery discharge upon squeezing the sebaceous cyst on the scrotum worrisome?

Answered by
Dr.
Dr. Kakkar S.

Dermatologist

Practicing since :2002

Answered : 8413 Questions

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Posted on Mon, 15 Oct 2018 in Sexually Transmitted Diseases
Question: Hello Doctors,
I recently started to obsess over genital herpes. I was diagnosed with genital warts last XXXXXXX and did have them treated and resolved. Dealing with that was very difficult and stressful.
Due to that I’ve become rather obsessed with checking my genital area in search of other abnormalities. I recently shaved down there about 6 weeks ago and since then have experienced a lot of paranoia. My genital area is probably 60% covered in sebaceous cyst (Shaft and Scrotum). Some are very small, and others are the size of a grain.

So here is my problem…

1.     2 weeks after shaving I experienced a red rash and red bumps in my genital area I took this matter to the Urgent Care and the P.A diagnosed it as being Folliculitis and Ring worm on my inner thigh. He prescribed a cream and told me not to shave so close.

2.     A few days later I noticed one of the bumps seemed to be redder and inflamed more than the others. (This was on the top of my penis shaft) I thought it may had been herpes and that the opinion of my dermatologist would be more accurate. So, I did take this matter to my dermalogist and he confirmed that it was also Folliculitis (He noticed a small hair coming through the red mark on my shaft). Said it would most likely take a week for the swelling to go down. It did, and I moved on. No blistering/scabbing took place


3.     After 2 weeks of visiting my dermatologist I noticed another red spot on the side of my scrotum (I personally thought it was an inflamed sebaceous gland as I have dealt with them in the past) I took this matter to another Urgent Care. He said that it was just an infected Sebaceous gland. Told me to stop obsessing and allow it to heal. No blistering took place. But I did pop it with a needle. A small amount of white cheesy substance leaked out.

4.     Again, roughly 2 weeks later I noticed another inflamed Sebaceous gland and I was very tempted to take this matter to Urgent Care but brought myself not to. I’m trying to control my anxiety and tell myself that every little skin condition doesn’t require (URGENT CARE). So again, it was obvious that this was just another infected Sebcause cyst (No blistering, just red and light pink colored) looked just like the other infected gland that I showed Urgent Care. The cyst consisted of two little hard white bumps under my skin on my scrotum (No blistering). Unfortunately, I became a little obsessed with it. I picked at it, squeezed it, scratched it, rubbed it over the course of 2 days trying to get it to pop. It eventually started to crack and slightly bleed, and it oozed a clear substance this turned into what looked like a little ulcer (No blisters, wasn’t sore, yellow scab). The wound has basically healed after a few days and isn’t worth rushing to see a doctor at this point. It almost looked like chaffing or rug burn do to the friction I was creating.

My last sexual exposure was around December 1st, 2016. I had an IGG and IGM blood test around XXXXXXX 22nd, 2017. About 28 weeks after my last sexual exposure. The IGG and IGM came back negative for HSV2 and IGG positive for HSV1 and IGM negative for HSV1. (I have suffered from cold sores since being a child, so the positive wasn’t a surprise). I’ve read that the IGG can be considered conclusive at the 6 month point with 95% accuracy and that it doesn’t miss much HSV2. I also read that having HSV1 orally and in the genital area is very rare (1% Probability) after reading up Terri Warren’s blog. According to her she’s been and expert in HSV for nearly 30 years.

So, what concerns me is my last inflammation with the Sebaceous cyst on my scrotum. Is the yellow scabbing and watery discharge normal after picking at it? (No blistering) On a side note: I haven’t been sexually active in nearly 16 months and don’t remember any sort of genital sores developing after my sexual experiences.
Are my anxieties getting the best of me or should I seek additional testing?
I was given Ideally the same diagnose by my dermatologist and 2 Urgent Care Physician assistants along with a negative HSV2 blood test. The odds telling me that I shouldn’t be worrying but I do…

So could you give me your unbiased opinion on the yellow scabbing and watery discharge after pinching it.
doctor
Answered by Dr. Kakkar S. 45 minutes later
Brief Answer:

Your HSV test is conclusive.

Detailed Answer:

Hello. Thank you.

Your HSV screening tests are conclusive. An intervening period of 12-16 weeks is considered sufficient for a screening test for HSV to be considered reliable and conclusive.

Since you tested 6 months after sexual exposure so your test is definitely conclusive. Most likely the yellow discharge and stabbing gas nothing to do with herpes.

It may have been due to secondary bacterial infection. Therefore I won't suggest any further test for herpes.

Hope I have answered your question. Let me know if I can assist you further.

Take care!

Regards
Dr. Kakkar S,
Dermatologist
Above answer was peer-reviewed by : Dr. Kampana
doctor
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Follow up: Dr. Kakkar S. 10 hours later
Thank you!

I have a few more questions....

Do genital herpes normally have the same appearance as they do when a break out happens on the lips? Painful (water blisters)? Would a break out happen on the scrotum?

Is it likely that HSV1 can be on 2 different body locations?
Is it likely that I could be part of the missed 5% on the IGG-HSV2? The test was HerpeSelect

Thank you
doctor
Answered by Dr. Kakkar S. 19 hours later
Brief Answer:

Regarding herpes simplex virus infection.

Detailed Answer:

Hi!

Herpes usually present as a grape like cluster of fluid filled vesicles which soon rupture to leave superficial painful erosions.

HSV 1 usually causes oro-labial herpes/cold sores whereas HSV 2 commonly causes genital herpes. However, either type of HSV may cause oral or genital infection.

Genital sores of herpes may be found either on the shaft or base of penis, scrotum, pubic region or perianal region.

Same type of herpes simplex virus may cause oral as well as genital infection.

In the absence of any symptoms a negative Herpeselect usually is 100% conclusive at 12 - 16 weeks after infection.

Hope I have answered your question.

Regards,
Dr. Kakkar S.,
Dermatologist


Above answer was peer-reviewed by : Dr. Vaishalee Punj
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