I get cold sores a lot. Does that mean I should worry about every little bump below the belt?

C

B

A

I get cold sores every month, which I suppress pretty well with medication.  My concern is that I may autoinoculate and spread it to my genitals; in fact, every time I have a pimple, ingrown hair or tear down there I panic!  How does the appearance of genital Herpes Simplex Virus Type 1 (HSV-1) differ from other more benign conditions? Is it unreasonable to end up at the gynecologist every time one of these other things appears? 

Great questions.  Let’s tackle them one by one.

Is it unreasonable to end up at the gynecologist every time something looks funny down there? 

Absolutely not.  The only way to truly find out what you’re dealing with in these situations is by consulting with an expert whose advice you trust.  Sometimes even your doctor won’t be able to tell by just looking – the same problem can look very different in different people, or even at different times in the same person – so she can do other tests to help you figure out what’s going on.

Can you autoinoculate yourself and spread HSV-1 it to your genitals?

Unfortunately, the answer to this one is yes.  People tend to think of Herpes Simplex Virus 1 (HSV-1) as the “cold sore” virus and HSV-2 as the “genital herpes” virus.  But both HSV-1 and HSV-2 are spread by direct skin-to-skin contact, and either can infect the mouth or genitals.  So if you were to touch a cold sore on your mouth and then touch your genitals, you could theoretically cause an outbreak down there.  The good news is that medication lessens the duration and severity of outbreaks (which tend to decrease in frequency and severity over time on their own anyway), so if you are staying on top of your cold sore outbreaks with suppressive medication, the odds of you doing this are very, very small. 

How does the appearance of genital Herpes Simplex Virus Type 1 (HSV-1) differ from other more benign conditions?

This is a tough one.  Like I said, many conditions that can affect the genitals look like Herpes and sorting them out isn’t always as easy as laying eyes on the situation.  That being said, some of the more common conditions do have typical characteristics.

Folliculitis: is inflammation of a hair follicle (“ingrown hair” or “shave bump”).  It happens when hair follicles are damaged by friction from clothing, a pimple or shaving and then get infected with Staphylococcus Bacteria (“Staph infection”).  They are red, inflamed areas that usually look like a pimple and have a hair in the center of it. They can be treated with anything from warm compresses to antibiotics.

Molluscum Contagiosum: are small, painless bumps that are flesh-colored and usually have a dimple in the center.  They may be red if they get irritated.  They’re caused by a poxvirus and are treated like genital warts caused by HPV.

Herpes: typically appears as a group of red blisters or ulcers.  Unlike molluscum, genital warts and (usually) folliculitis, these lesions are VERY painful and can be preceded by flu like symptoms.

There’s a picture of each of these conditions to the right.  Can you tell which one is which?  (Click to enlarge.  Answers below)

This list is far from complete, and again, no one can make a diagnosis from looking at a picture online, so if something doesn’t look right down there, be sure to see your women’s health care provider right away.  If you are a student at Ohio State, you can make an appointment with our Women’s Services Clinic; they’re always happy to help.

John A. Vaughn, MD
Student Health Services
The Ohio State University

Answers: A = Molluscum Contagiosum, B = Herpes, C = Folliculitis

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