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Suggest Treatment For Blisters On Scrotum And Genital Warts

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Posted on Wed, 8 Apr 2015
Question: Hello i a few questions all relating to the same issue. I was recently diagnosed with genital warts and got treatment with Cantharidin and at the time i noticed that effect of the medication made the skin swell and blister. Later i noticed that i had a blister on my scrotum, im not sure if the doctor applied any there or accidentally dripped some. I also noticed the day i got the treatment that touching the area it was a bit sore like the other areas that the doctor treated (i also had him check down on my scrotum as well) I noticed this by scratching the area and then checking myself out but the area i scratched has changed a bit and im wondering if this is normal reaction to the Cantharidin the parts look more red and ulcer like now. And my worry is that it might be herpes (had doctor look at it today and he stated that they did not look like a typical herpes outbreak), he also stated that Cantharidin can ulcer the skin as well but that if they reappear then he would be more worried. Also my last sexual Encounter was in december and the one before that was in november and this is the first time this stuff has shown up. So my question is can Cantharidin cause my symptoms and i have read typically the herpes shows itself more often then not and soon and fairly painful. I also asked the doctor if i needed a blood test for it and he didn't seemed to worried. i have had another online doc check these pics out and he agrees with my doctor that they more then likely caused by my recent treatment and most likely do not look like herpes and i want a third opinion to make sure. i also have a few other pictures as well if you need to see more.
doctor
Answered by Dr. Dr. Kakkar (40 minutes later)
Brief Answer:
Kindly upload more images

Detailed Answer:
Hello. Thank you for writing to us

I have taken note of your query and I have also reviewed the Images.

In some of the Images I can see erosive lesions on scrotum and in other images I can see dried up, crusted, dark lesions.

After examining visually I cannot rule out genital herpes with surety unless you are certain that this is indeed due to direct contact with cantharidin.

In a normal relaxed position, does this area normally come into direct contact with the wart treated area?

I would like to have a look at more images. Kindly upload few more.

Regards
Above answer was peer-reviewed by : Dr. Shanthi.E
doctor
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Follow up: Dr. Dr. Kakkar (29 minutes later)
The dryed up ones are an earlier picture they now look more wet and yes the area at rest could very well brush up against where i was treated with the chemical are herpies usually small and lots of bumps then bigger bumps? I will upload pictures of the treatment area and what the spots look currently
doctor
Answered by Dr. Dr. Kakkar (20 minutes later)
Brief Answer:
Genital herpes usually presents as discrete, grouped, multiple, erosions; lab testing required

Detailed Answer:
Hi,

Genital herpes usually presents as discrete, grouped, erosions/ breaks in genital skin (usually 5 mm or so in size) which may coalesce to form larger polycyclic lesions.
The number of erosions can vary from a few (i.e just 2-3) or may be numerous.

I have reviewed the new Image (image.jpg).
There are multiple discrete erosions on scrotal skin in this Image. This looks like genital herpes, clinically. I cannot exclude this possibility clinically. The lesions are perfectly round or oval just as typical genital herpes. Therefore, I will keep genital herpes as my differential
Lab tests would be required and I would suggest a blood test for HSV Type 1 & 2 (IgG and IgM) to be absolutely sure about the diagnosis.

Regards
Above answer was peer-reviewed by : Dr. Shanthi.E
doctor
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Follow up: Dr. Dr. Kakkar (29 minutes later)
What are the stages of genital herpes outbreak i thought crusty looking came after more wet open wounds (ulcers) and does it usually take almost 4 months for these types of ulcers to show up?
doctor
Answered by Dr. Dr. Kakkar (24 minutes later)
Brief Answer:
Genital herpes may not present soon after it is acquired

Detailed Answer:
Hi

Yes, genital herpes initially presents as fluid filled lesions that may soon rupture to form erosions. The lesions subsequently dry up/ crust.
Regarding the time period, genital herpes can present weeks or even months after the infection is first acquired.

Regards
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Dr. Kakkar (12 minutes later)
One last question does the crust phase come before the ulcer phase?
doctor
Answered by Dr. Dr. Kakkar (7 minutes later)
Brief Answer:
Erosions precede crusting in genital herpes

Detailed Answer:
Hi.

In genital herpes, erosion is followed by crust formation not vice versa.

Regards
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Dr. Kakkar (45 minutes later)
thats good to know as when I went to the doctors on March 18, 2015 they looked more crusty and over the day became more of the ulcer looking sores (the crust slow fell off during the day as I was looking at the sores and kind of loosing it). As well i got the Cantharidin treatment on Monday the 16, 2015 and the doctor looked at my scrotum and did not see any herpe signs. in that infection would it develop possibly blisters, crust up and then become ulcer that they are now or is it more likely that the Cantharidin spread or dripped onto my scrotum and caused this chain of events?
doctor
Answered by Dr. Dr. Kakkar (21 minutes later)
Brief Answer:
Get tested for Hsv by ELISA

Detailed Answer:
Hi.

In genital herpes the lesions would be erosions initially and then they would crust/ dry up.
Whereas if they are cantharidin induced they would be scabs from the beginning and if you would peel then off they would reveal raw areas. Therefore, from your description they seem like cantharidin induced.

They could be cantharidin induced... Mind you, I am not ruling out that totally as yet..

However, they look perfectly round or oval like lesions of genital herpes whereas a dripping event wound not cause perfectly round erosions.

Moreover your treating doctor too also said that he would be concerned if these would recur implies that even he considers this possibility but not with surety at present.

This is a tricky situation. Testing should resolve this confusion.

I recommend you to get tested with HSV ELISA. You can take this test even today since you last contact was in december...so that is enough time for antibodies to appear in blood.
If it turns out to be negative that would be conclusive that it was actually cantharidin induced Or vice versa.

Regards.
Above answer was peer-reviewed by : Dr. Neel Kudchadkar
doctor
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Follow up: Dr. Dr. Kakkar (23 minutes later)
okay as I was not completely paying attention to what the doc was doing down there if he applied that medication on the scrotum (as he may have found a wart) would that make it more rounded? also I did have him look down there and if there was some kind of Herpes outbreak as to where we are in the possibly outbreak stages would he have seen something taking into account the short time period and what they are currently looking like ulcers (stages go, redness, to blisters, to ulcers, to scabs) and he also used a round shaped wood looking applicator.
doctor
Answered by Dr. Dr. Kakkar (2 hours later)
Brief Answer:
A short sequence of events goes in favor of cantharidin induced scabs but herpes testing still advisable

Detailed Answer:
Hi.

That can be easily inquired from the treating doctor if he found any lesions suggestive of warts on scrotum and therefore treated it with cantharidin.
The lesions of non-primary / recurrent genital herpes usually take about 3-5 days to heal completely.
Since you got treated on 16th march and today is 19th march and if these were already scabs when you revisited your doctor on 18th I think there should have been some evidence of herpes already (erosions or blisters) on 16th and the doctor should have noticed it.
Going by this sequence of events the most likely reason for these scabs/ erosions is cantharidin induced.
A wart is usually oval or round so if there were warts then these scabs/ erosions would be oval or round as well.
I would still suggest you to test for genital herpes even if there is the smallest of possibility so as to clear all doubts. This is my intention since my first reply.

Regards
Note: Consult a Sexual Diseases Specialist online for further follow up- Click here.

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
Answered by
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Dr. Dr. Kakkar

Dermatologist

Practicing since :2002

Answered : 9612 Questions

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Suggest Treatment For Blisters On Scrotum And Genital Warts

Brief Answer: Kindly upload more images Detailed Answer: Hello. Thank you for writing to us I have taken note of your query and I have also reviewed the Images. In some of the Images I can see erosive lesions on scrotum and in other images I can see dried up, crusted, dark lesions. After examining visually I cannot rule out genital herpes with surety unless you are certain that this is indeed due to direct contact with cantharidin. In a normal relaxed position, does this area normally come into direct contact with the wart treated area? I would like to have a look at more images. Kindly upload few more. Regards