Itchy Symptoms in the Groin: A Urology Perspective

Q: Itchy Symptoms in the Groin: A Urology Perspective

Hello： 1) It can only be referenced, and it cannot be determined if the current symptoms are caused by herpes. <br>2) There is a possibility of transmission upon contact, and herpes is more contagious when blisters are present, so it is important to use protection and be cautious

I would like to ask about an itch in the coronal sulcus area without any wounds?

Hello Dr.
Du, I had high-risk sexual behavior at the end of December last year, which included unprotected oral sex and protected intercourse.
In early January, I experienced redness of the scrotum, burning sensation in the penis, and pain in the testicles.
I am concerned whether this could be a simple herpes infection.
In early February, I returned to my home country and consulted several doctors.
Most of them diagnosed me with scrotal eczema and folliculitis.
I also paid for tests (high-risk sexual behavior occurred about five weeks prior) for HIV, syphilis, chlamydia, and gonorrhea, all of which were negative.
However, the test for herpes showed that HSV-1 IGG was 49.70 index (negative <0.90) and HSV-2 IGG was 0.50 (equivocal 0.90-1.09, positive >=1.10).
I understand that recent infections should be assessed with IGM, but I did not have that tested.
Other doctors mentioned that my symptoms were not typical, as I do not have any blisters.
Question 1: Given that my IGG is very high, but I do not have oral herpes, does this count as a diagnosis?
Question 2: I read that many people in Taiwan are carriers of herpes.
If I have sexual relations with a woman who has oral herpes, will she develop genital herpes?
Question 3: I would like to know if asymptomatic shedding of herpes can still pose a risk of transmission to a partner, even if condoms are used and antiviral medications are taken.
If so, what recommendations do you have? (Other doctors said that as long as there are no symptoms, there is no risk.)
Question 4: At the end of February, I noticed a small, itchy spot on the right side of the penile corona and under the foreskin.
It became very itchy and later painful, but I did not see any wounds or abnormalities.
This has persisted for almost two weeks.
I have tried antiviral medications (for herpes), herpes ointment, antibiotics, and Canesten cream, but the itching returns after a few days of application.
The penis feels tight due to the irritation.
Could this be due to the steroid ointment prescribed by a previous doctor causing thinning of the foreskin and leading to a bacterial infection?
Question 5: Could it still be eczema spreading to the foreskin?
Question 6: Since I am in a small town in Australia where there is only a family medicine clinic (and it is very expensive), could you suggest what I should tell the local doctor to investigate further? Otherwise, they will likely just prescribe antibiotics again.
Thank you, Dr.
Du, for your help.
I really appreciate it.

MARK, 20~29 year old female. Ask Date: 2020/03/06

Dr. Du Shixi reply Urology

Hello: 1) It can only be referenced, and it cannot be determined if the current symptoms are caused by herpes.
2) There is a possibility of transmission upon contact, and herpes is more contagious when blisters are present, so it is important to use protection and be cautious during oral sex.
3) The virus may be contagious even before the blisters appear, so safe sex practices are recommended; it is not advisable to judge solely based on the presence of blisters.
4) The ointment should not cause this phenomenon; it is still likely due to sexual activity.
Safe sex practices are recommended, and one should be aware of any wounds or blisters that may occur, as they could indicate an early stage.
Normal test results may still indicate a latent period.
5) In my personal opinion, eczema is often half the cause, with only a small chance of being something else; if it is spotty, it usually presents as a patch of red spots.
6) Engage in safe sex and maintain cleanliness and dryness.
Wash with clean water and dry thoroughly, avoid tight clothing, and pay extra attention if uncircumcised.
Wishing you good health.
● Low-risk sexual activities: include mutual masturbation, mutual rubbing, deep kissing, bondage, protected deep foreplay, oral sex with condoms or dental dams, anal sex, and vaginal intercourse.
● Moderate-risk sexual activities: include withdrawal before ejaculation, sharing sex toys, unprotected deep foreplay, oral sex before ejaculation, and oral sex during menstruation.
● High-risk sexual activities: include unprotected anal sex, vaginal intercourse, oral sex during menstruation, retaining semen in the mouth, sharing needles, syringes, and bleeding during sexual activity.

Reply Date: 2020/03/06

More Info

It sounds like you're dealing with a complex and concerning situation regarding your symptoms and potential herpes infection. Let's break down your questions and concerns one by one.

Question 1: High IgG Levels for HSV Without Symptoms
The presence of high IgG levels for HSV-1 indicates that you have been exposed to the virus at some point in your life. However, it does not confirm an active infection, especially if you are not experiencing typical symptoms like cold sores. The absence of symptoms does not rule out the possibility of having genital herpes, but it does suggest that you may not have an active outbreak. It's important to note that many people carry the herpes virus without ever showing symptoms.

Question 2: Transmission Risks
If you engage in sexual activity with someone who has oral herpes (typically HSV-1), there is a risk of transmitting the virus to the genital area, potentially causing genital herpes. However, the risk of transmission is higher during an active outbreak when sores are present. If the person with oral herpes is asymptomatic, the risk is lower, but not zero. The virus can still be shed and transmitted even when no visible symptoms are present.

Question 3: Asymptomatic Shedding and Transmission
Asymptomatic shedding of the herpes virus can occur, meaning that even when you do not have visible symptoms, the virus can still be present on the skin and potentially transmitted to a partner. Using condoms can reduce the risk of transmission, but it does not eliminate it entirely. If you are concerned about transmission, discussing the use of antiviral medications with your healthcare provider can be beneficial, as these can help reduce the frequency of outbreaks and the risk of transmission.

Question 4: Persistent Itching and Pain
The persistent itching and pain in the area you described could be due to several factors. It could be a result of irritation, a secondary bacterial infection, or even a reaction to medications or topical treatments you've used. If you have been using corticosteroid creams, they can thin the skin over time, making it more susceptible to irritation and infection. It’s crucial to avoid self-diagnosing and self-treating, as this can sometimes exacerbate the problem.

Question 5: Eczema or Dermatitis
The symptoms you describe could also be indicative of a dermatological condition such as eczema or contact dermatitis, which can cause itching and discomfort. If the rash or irritation is spreading, it may be worth considering this as a possibility.

Question 6: Seeking Further Medical Help
Given that you are in a rural area in Australia with limited access to specialists, it might be helpful to communicate your symptoms clearly to your general practitioner (GP). You can request a referral to a dermatologist or a urologist, as they specialize in skin and genital issues, respectively. You might also want to ask about specific tests for herpes, such as a PCR test or a culture from the affected area, to confirm or rule out an active infection.

In summary, it’s essential to have open communication with your healthcare provider about your symptoms and concerns. They can guide you on the best course of action, whether that involves further testing, referrals to specialists, or adjustments to your treatment plan. Remember, managing herpes and related symptoms can be complex, and it’s important to approach it with a comprehensive strategy that includes both medical treatment and lifestyle adjustments.

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