Differences between herpes lesions and cysts/pimples

[VeryThankful]

Hello Nurse Warren.

A few weeks ago I had what I thought was just a pimple in my the crease of my groin at the scrotum. There is some hair there but not a lot and I couldnt be sure if the ‘pimple’ was on a hair follicle or not. I had sexual relations with HSV 2 positive genital female a few years ago and no one since. I had a negative western blot six months after my last encounter for type 2 and always knew I had type 1. I didnt get the ‘pimple’ tested… maybe I should have… what do you think?

I was hoping you could explain any tell-tale differences between herpes lesions and other skin conditions. My lesion ‘popped’ pretty readily. I did not see any white waxy stuff like with a cyst (which worries me), but it definitely felt like it needed to be popped with the type of under-the-skin welling up you would feel from a pimple. And the fluid was reddish, sanguineous (big word) blood like… not clear or straw colored like I read herpes lesions are? It also had a lot of force behind it when it popped because it shot out (gross I know, but in my mind herpes lesion pop like water blisters and more like leak out). Are herpes lesions ever swollen and ‘squirt’ out stuff with pressure like that? I’m sorry for being gross, again.

Also, when I was checking the internet for info, I ran across this article where you were interviewed:
http://www.h-book.info/report-conversations-top-hsv-researchers-terri-warren-r-n-anna-wald-m-d-m-p-h/

In it, it reads “Terri claimed that the Western Blot, the gold standard of HSV testing, was “not perfect either,” but when asked about its degree of accuracy, she called it better than 99%.”
–What is not perfect about the test?
Also it says “In particular, Dr. Wald cited low sensitivity to HSV-1 (sometimes the test misses HSV-1 completely) and faulty specificity (sometimes the test thinks HSV-2 is HSV-1) as particular problems with the Focus ELISA.”
–Does the WB have specificity problems with types 1 and 2?

[Terri Warren]

Herpes lesions don’t normally “pop” and the fluid inside is not red-tinged. I have not seen herpes lesions “pop” and come forcefully out.

I have had 9 patients in my practice who had positive swab tests (either culture or PCR) and a negative western blot for HSV 2. The western blot does not appear to have problems with HSV 1, but the ELISA clearly does. It misses 25% of HSV 1 infections, compared to western blot.

Terri

[VeryThankful]

Slightly unrelated question… I read that subclinical shedding is high just before and just after a lesion… is it know how long this auxiliary heavy invisible shedding period usually lasts? Would those same invisible periods apply the same to thicker areas of the skin, such as in cases of whitlow or thigh or buttocks outbreaks?

[Terri Warren]

Thick skin does not shed, no. Not at all. The skin is too thick for virus to get out.
Shedding varies so much from person to person that we cannot know how long it usually lasts. On average, people who have HSV 2 genital infection shed virus on about 13% of days out of 100.

Terri

[VeryThankful]

Last Question, Terri. This forum has been ultra helpful!

All my fears spawned from dating a girl who had genital HSV2 a few years ago. Recently, I had a second WB done that was negative, thankfully. I had some symptoms from back then though, that I wanted you to comment on nonetheless.

I had a significant rash on one forearm when I was dating my ex. At the time, I didnt know herpes could infect any body part, and I assumed it was poison ivy. I had been in contact with some bushes in my landscaping, at least briefly, and the rash was itchy if I remember correctly. I fear ‘what ifs’ that this may have been herpes and I will never know… I do not recall having any spots on my hands or fingers though… so would that help my case that it wasnt herpes? I was in contact with many people including little ones in my family with that rash, so it is a nagging worry. I thought about talking to my doctor about swabbing my arms now, but as you said that skin doesnt shed… Anyway to test if I ever had poison ivy?

My ex also would regularly get what we believed to be uticaria rashes/eczema in combination with burning watery eyes. Any chance those rashes could be have been herpetic eczema, or is that a more severe thing?

What is your experience with folks who have herpes outside of the oral or genital area? Any patterns or defining characteristics? How weird would forearm herpes be with no signs anywhere else?

[Terri Warren]

I have only once in 33 years since a herpes lesion on an arm – often on a hand but only once on an arm.
I do not think you have herpetic eczema because your western blots are negative. And you have two! If you were my patient, I would encourage you to put aside these worries for good that you contracted HSV 2 from this person. You are using the very best test and you are negative. You can count on it.

Terri

[Author]

Posts