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What does an tender and inflamed perineum indicate?

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General Surgeon
Practicing since : 2002
Answered : 3190 Questions
Hi, I recently had a HSV1 sexual encounter. Women in question had HSV1 virus as a rash on her forehead a few times in her life, but had no obvious symptoms during unprotected/protected intercourse. She also gave me 3-seconds of oral sex unprotected. I developed a itch/tingly sensation on my penile shaft 2 weeks after exposure. The itchy patch was inflamed but never produced a sore or blister. Doctors advised it didnt look like herpes. Fast forward, lesion went away after 4 weeks. My current issue is my perinum (taint). I uncovered a small blister which I popped (foolishly) and then rushed to get swabbed 30 hours later. Doctor advised the blister had dried and was almost healed that quickly, it was still swabbed and result was negative. If not herpes, what would cause a single blister down there?? My current issue is I have had a sore/red perinum the last week and a half. It burns throughout the day and feels like chafing when walking. I check every day and no lesion has formed. IS THIS HERPES? No sores, but a tender, inflamed perinum. I have taken 6 blood tests from 2 weeks exposure up to 7 weeks. 3 - IGM tests at 3 weeks, 6 weeks, and 7 weeks. Negative for HSV1 and 2. 3- IGG type specific tests at 2 weeks, 5 weeks and 6 weeks. All negative. HSV1- 0.26 and HSV 0.08. Please look at the lesion/pimples on my buttocks that just formed. They are red as I picked them and squeezed them. Is this Herpes??? 2nd photo is my inflamed perineum. Is this typical of herpes?? Should I retest at 12 weeks for blood. Please help!!
Posted Fri, 7 Feb 2014 in General Health
Answered by Dr. Deepak Kishore Kaltari 3 hours later
Brief Answer: The lesion is likely to be Intertrigonitis(fungal) Detailed Answer: Hi Welcome to Healthcare-Magic Greetings of the day I do understand your concern and apprehension. First and foremost let me reassure you, that it's unlikely to be Herpes lesion. Based on your history , clinical photograph and investigation there is no point in favour of hsv except that of sexual encounter with probably infected person. From the clinical photograph of your perineum it appears to be Intertrigonitis( fungal infection of body folds). Presence of hairs and sweating which provide moist environment favour the growth of fungus. Single blister that you developed is likely to be folliculitis. It's more common in hairy individuals. Neither the clinical picture, or laboratory investigation favour diagnosis of herpes. As this sequential test done are negative it's unlikely that 12 weeks test will yield anything. Rest be assured there is no cause for concern. In case you require any further assistance, will be glad to assist you. Take care Best Regards Dr Deepak Kishore MBBS, MS, MCH Consultant Surgeon
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Follow-up: What does an tender and inflamed perineum indicate? 21 minutes later
Dr. XXXXXXX thank you for the prompt response. How accurate would say the IGM herpes test is? I have read the test unreliable as it can cross with other illnesses/viruses, but its intended to catch current HsV infections, especially during symptoms. I took that test during symptoms and were negative. Should I feel confident in that result with that test?? What are your thoughts? Also, what would you recommend for treatment of the perineum redness and burning? Would Lotrimin work? Please advise? Also, I had a lesion form in between my buttocks last night which formed a white head by the morning. It popped with a little white stuff coming out. The pimple then immediately went that also folliculitis or can it be a symtoms of herpes? How confident should I be at my 6/7 week tests? In your experience how quickly have patients tested positive via blood for herpes? What are my odds of testing positive at 3 months and beyond? Thank you for your expertise as I search for answers.
Answered by Dr. Deepak Kishore Kaltari 2 hours later
Brief Answer: 12 week test could possibly be negative Detailed Answer: Hi Greetings As you have done the test at Interval of time and there has been no sero Conversion it's highly unlikely that you are infected. It's important to note that serological test are not sensitive. The median incubation period of hsv is 26 days, as you have done serological test well beyond this period I and its negative it's unlikely that you are hsv infected. It is the recent sero conversion( negative test becoming positive) which is more informative. The confirmatory test is Hsv DNA PCR from scrapping of the vesicle. The clinical picture is not in favour of diagnosis of hsv. Rest be assured there is no cause for concern. Take care Best Regards Dr Deepak Kishore Consultant Surgeon
Above answer was peer-reviewed by
Follow-up: What does an tender and inflamed perineum indicate? 9 hours later
Dr. XXXXXXX I already had a viral culture done on my perenium where the blister was so im not sure how much more accurate a PCR sample would be. Please advise. More IMPORTANTLY: I have kept my anxiety down during sleep but I have been having serious NIGHT SWEATS for about a week now every day. Its like my body is fighting either this new HSV virus or something else. Give my stated symptoms, single blister, inflamed perienum, pimples on buttocks, would could cause such frequent night sweats. Is this a common symptom of a new Herpes infection? I know you mention no cause for concern, but my body is telling me different. I feel my body hasnt built enough antibodies which is why my blood is negative. Please advise.
Answered by Dr. Deepak Kishore Kaltari 20 minutes later
Brief Answer: Herpes infection is ruled out Detailed Answer: Hi I do understand your concern and apprehension. Let me once again explain to you in depth. 1. Single blister like lesion is unlikely to be Herpes , it is folliculitis. Herpes lesion occurs in crops and also when one contracts the infection therw is systemic symptoms like fever, myalgia, lymph node enlargement. You have had none. Clinical diagnosis is definitely against Herpes. Just night sweat could possibly due to anxiety about the disease: fear of known disease. 2. In the Presence of newly acquired hsv infection, even if the sero conversion has not occurred which is very rare, negative culture which you have had almost certainly rules out the possibility of hsv . PCR is very much sensitive and specific. Almost nearing 100%. 3. Pain associated with hsv lesion is very excruciating. Further making the diagnosis of hsv unlikely. On carefully analysing the above things diagnosis of hsv is totally ruled out. Further I would advise the following for treatment of your perineum lesion 1. Keep the area clean and dry 2. Hot Seitz bath: to a tub of lukewarm water add a handful of common table salt , sit in it for 15 to 20 minutes every time. Do it 2 to 3 times a day. After the above kindly dry the area with a soft napkin by dabbing. DO NOT RUB: Rubbing action will further cause excoriation 3. After Seitz bath apply Steroid and antifungal ointment. The lesion will definitely start improving in a week time. I do understand your apprehension, I assure you I will be there for you for any assistance and advice you need. Take care Best Regards Dr Deepak Kishore MBBS, MS, MCH
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