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What causes burning sensation of perineum and buttock followed by blisters?

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HIV AIDS Specialist
Practicing since : 1974
Answered : 2718 Questions
Hi, My concern is possible exposure to HSV1. Had protected sex, but unprotected oral sex (was the receiver) from a woman orally HSV1 positive. She had no sores or symptoms during this encounter. 2 weeks post expsure: itchy red/irriated lesion formed on penile shaft. Never blistered or ulcered, but itched and was persistent on/off for a month. Its now gone. 4 weeks post: Inflamed red perenium and anus. Single blister formed near anus, it was swabbed negative. From there anus and penis discharged occurred. Also discomfort/ burning in penis. 5 weeks post: Night sweats for 2 weeks straight, nerve twitches in legs. Burning perenium and skin on buttocks. Second swab was performed on perenium, result negative for herpes 1 & 2. BLOOD WORK: IGM negative for herpes at week 3 and 5 BLOOD WORK: IGG type specific @ 2 weeks, 6, 8, 13 weeks. Negative for herpes. Most recent test at level HSV1: 0.26 and HSV: 0.02. Negative is less than 0.90. Full panel STD test was done. Negative for all common STD's. Please review my current and remaining symptom. I have a "pimple" like lesion on my buttocks with another close to it...this followed the burning sensation. I fear herpes. What else could my symptoms be? - First photo of lesion - Second photo of lesion zoomed in -Third photo close up after I "squeezed" and irriated it. Small liquid came out. -Final photo. 2 very small sores on side of tongue. I am prone to cankers sores, is this herpes or just another canker sore i frequently get? Please advise. Are these herpes lesions? Can i trust bloodwork at 13 weeks?? I still having burning on buttocks as my last remaining symptom.
Posted Tue, 18 Mar 2014 in General Health
Answered by Dr. S. Murugan 8 hours later
Brief Answer: Seems to be Herpes Smear test will be conclusive. Detailed Answer: Hi, Welcome to HCM. Thanks for sending your query. You had a protected vaginal sex and an unprotected oral sex. The lesions over your buttock seems to be Herpes simplex lesions. Burning sensation of perineum and buttock area followed by blisters are indicating Herpes only. Sometimes antibody formation could be delayed. Have you done these IgM and IgG for both HSV1&2 or not? Even then a smear test (Tzanck's test) and viral isolation will prove the Herpes. Don't worry about the blood report. Have a course of ACICLOVIR or Famcyclovir or Valcyclovir in adequate doses for a week as per the guidelines of your physician will solve your problem. Nothing much to worry and get well soon. Dr S.Murugan
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Follow-up: What causes burning sensation of perineum and buttock followed by blisters? 11 minutes later
Dr. As I mentioned in ny query. I have taken the most up to date HSV blood tests which detect HSV anitbodies within weeks exposure. If you read my query, my tests were type specific and showed negative for BOTH types of herpes. I also took the tests within the herpes window period. Also, my single blister was swabbed negative via culture. I have had no such blisters since. Just pimples My photos are not blisters but rather pimple looking bumps. My dermatologist deemed these "folliculitis", but i wanted a second opinion. Your recommended test is not up to date on the most sophisticated available. Could you please refer my question to another doctor and have them review my photos. What about my sore on my tongue? I didnt see a response on that. All bloodwork and swabs have been negative. I did not swab the buttocks pimple because it showed today and my dermatologist in the past deemed this not herpetic. I will not take valtrex or your recommendations for medicine as it will skew my blood work that i will take moving forward. This has been proven. With all due respect, Please forward my query to someone a littler more up to date on hsv. A smear test is rarely used and not recommended on a hsv diagnosis..
Answered by Dr. S. Murugan 16 minutes later
Brief Answer: Folliculitis contains pus and clear fluid. Detailed Answer: Hi, Welcome back. Pictures sent by you showed clear blister rather than a pimple or a pustule. In folliculitis it will contain pus rather than a clear fluid. Regrading your test you had mentioned in your first statement as negative both for HSV 1&2, but it was not mentioned in your results typed. So only I asked whether it is for HSV1 or 2. Regarding your tongue lesions it is very difficult to say by inspection alone whether it could be a herpetic lesion or a canker sore especially when there is a history for canker sore and a history of oral sex. I could not direct your question to someone else from my side and you could try with HCM people. Dr S.Murugan
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Follow-up: What causes burning sensation of perineum and buttock followed by blisters? 50 minutes later
Dr, from what i gather herpes lesions occur in lesions. This is a single small bump with another small one near it but nut clustered or on a large red base. Ill get this swabbed tomorrow in case. The lesion does not hurt and is not bothersome. From what i gather, arent herpes lesions painful or bothersome? Also, why would random one form on my buttocks and not on penis? Again, many herpes specialists recommend HSV type specific blood tests between 12-16 weeks of exposure for accurate result. I have tested negative for both types within this time frame. Also negative IGM for both types on week 3,6, and 7. Anything else to add. Ill get these swabbed tomorrow, but I just cant see how this could be a herpes outbreak considering all the negative bloodwork done. Please give me your last thoughts..
Answered by Dr. S. Murugan 2 hours later
Brief Answer: Isolated and painless lesions are possible in HSV Detailed Answer: Hi, Welcome once again. Good questions raised by you. As you rightly mentioned, Herpes Simplex usually occurs in grouped vesicles and subsequently grouped tiny ulcers. In some individuals it occur as single or 2-3 lesions also. Similarly Herpes Zoster is always painful. Hepes simplex would be painful (Tolerable) in certain individuals and in some they never felt pain at all. We come across herpes lesions in and around genitals and anus, even thigh in some individuals. Swab or smear test will be successful only who have good experience in microbiology or pathology to recognize the giant epithelial cells. How long you are having these lesions? Herpetic vesicles will never last longer than 24-48 hours and then become ulcers.If not so we have to think of other possibilities of vesicular eruptions of some other etiology. Dr S.Murugan
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