Can Herpes Appear on Pubic Hair? Skin Conditions

Can herpes appear on the pubic hair?

Question 47759: Inquirer: Tulong / Male / 41 / On August 9, 2007, I developed redness and swelling at the base of my pubic hair, accompanied by itching.
I applied a general topical ointment, which led to pus formation and then scabbing.
Recently, it recurred, so I went to a nearby dermatology clinic (the sign said they specialize in sexually transmitted diseases, but there was only one doctor).
The doctor took a quick look (about a second and a half!) and diagnosed it as herpes.
I received two injections and was given a seven-day supply of medication, but I was told I had to pay out of pocket, which wasn’t cheap! The doctor also advised me not to engage in risky behavior, but I clearly haven’t! Now I’m embarrassed to face my wife...
Could you please tell me, Director, is it really herpes? After researching online, I have a preliminary understanding, but isn’t herpes usually located on the genitals? Am I being deceived?

Xiao Long, 40~49 year old female. Ask Date: 2007/08/10

Dr. Zhang Zhibo reply Dermatology

Hello, you have described symptoms that are consistent with herpes.
Generally speaking, herpes simplex virus infections present with a clustering phenomenon, initially characterized by a tingling sensation followed by the appearance of vesicles.
In the early stages, these vesicles are clear and accompanied by slightly erythematous rashes around them.
Subsequently, they may undergo purulent changes (non-infectious), and sometimes a secondary Staphylococcus aureus infection can occur, leading to pus formation.
A significant characteristic of this condition is its recurrent nature, often appearing multiple times a year, with lesions typically resolving within a week regardless of treatment.

If you need to pay out of pocket for medication, antiviral drugs are the specific treatment, which can be quite expensive.
If there is redness and swelling at the base of the pubic hair accompanied by itching, and vesicles appear after scratching, you should consider the possibility of vesicular impetigo, which is related to bacterial infection rather than sexual contact.

Regarding your other question, "herpes does not only appear on the genitals," it generally manifests in the same dermatomal area, following the same nerve root.
In the image, S2 and S3 represent a specific region, regardless of the presence of pubic hair.
For a visual reference of the nerve roots, you can view the image at http://ramanathans.com/Dermatome.gif.
If this explanation is still unclear, I recommend discussing it further with your physician.

Reply Date: 2007/08/10

More Info

Herpes simplex virus (HSV) can indeed manifest in various areas, including the pubic region and the hair follicles surrounding it. The symptoms you described—redness, swelling, itching, and the formation of pus leading to crusting—are consistent with a herpes infection. While herpes lesions are most commonly associated with the genital area, they can also appear on the skin surrounding the genitals, including the pubic hair region.

Herpes is typically categorized into two types: HSV-1 and HSV-2. HSV-1 is often associated with oral herpes (cold sores), while HSV-2 is more commonly linked to genital herpes. However, both types can infect either area. The initial outbreak may present with flu-like symptoms, followed by the appearance of painful blisters or sores. These lesions can break open, ooze, and then crust over, which aligns with your experience of having pus and scabbing.

The diagnosis made by your dermatologist, although seemingly quick, is not uncommon in clinical practice. Experienced practitioners can often recognize herpes lesions based on their appearance and the accompanying symptoms. However, if there is any doubt about the diagnosis, it is reasonable to seek a second opinion or request further testing, such as a viral culture or PCR test, to confirm the presence of the herpes virus.

Regarding your concerns about being misled, it is essential to understand that herpes is a common sexually transmitted infection (STI), and many individuals may carry the virus without being aware of it. The stigma surrounding STIs can lead to feelings of shame or embarrassment, but it is crucial to approach the situation with a focus on health and treatment rather than guilt.
In terms of management, antiviral medications are typically prescribed to help reduce the severity and duration of outbreaks. It is also important to practice safe sex to prevent transmission to partners. Using condoms can significantly reduce the risk of spreading the virus, although it does not eliminate the risk entirely, as herpes can be present on skin not covered by a condom.

Additionally, maintaining a healthy immune system can help manage outbreaks. Stress, illness, and fatigue can trigger recurrences, so finding ways to manage stress and ensure adequate rest can be beneficial.
If you are experiencing recurrent outbreaks or have concerns about your diagnosis, consider discussing these with your healthcare provider. They can provide guidance on long-term management strategies, including suppressive therapy, which can help reduce the frequency of outbreaks and the risk of transmission.

In conclusion, herpes can indeed appear in the pubic hair region, and the symptoms you described are consistent with this diagnosis. It is essential to follow your doctor's recommendations and seek further clarification or treatment options if needed. Remember, open communication with your healthcare provider is key to effectively managing your health.

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