Hello,

Thanks for your query at DoctorSpring.com.

I can understand your difficulty coping with this frustrating situation. It seems like you have had an initial herpes infection (that was not properly treated with antiviral meds) when you were younger and now the dormant virus is causing you flare ups of the lesions on your penis. The best thing you can do is to avoid triggers that cause flare-ups. It is possible that heat and irritation can contribute to the recurrent lesions which are causing you much anxiety.

Here is what I suggest:

1. Do your best to avoid such triggers as heat and irritation by wearing loose underwear and clothing and allowing free movement and air to your genitals.
2. Sex can be a reason for flare ups as the friction can irritate the penis. During sex, use an organic water-based lubricant to ease the irritation and reduce outbreaks.
3. To reduce outbreaks and also decrease the chance of spreading infection to your partner, consider taking an oral antiviral pill everyday. Although this may be inconvenient (to take the pill everyday), it comes with minimal side effects and it has been proven to reduce transmission to partners and you have an opportunity to protect your wife as well.
4. Aciclovir is an older antiviral drug that is known to work well, and valacyclovir is a newer drug that when taken daily has been known to reduce the recurrence of outbreaks in infected individuals.
5. Make an appointment with a local infectious disease specialist or general practitioner and get your wife tested as well to determine whether or not she has been infected already. She may benefit from antiviral medication as well.

It is quite possible that you received a false negative report on your blood tests. Your history and the symptoms you are describing mimic herpes and this is the most likely diagnosis. Re-do the blood tests (during an outbreak if possible) as these are the times when the viral load is more detectable. If positive, discuss with your doctor about daily antiviral therapy. Other possibilities for your condition could be contact dermatitis from something that you are in contact with and allergic to, such as soap, lotion, condoms (if used), lubricants, and clothing. Take a mental survey of what might suspected allergens in your daily activity and consider what to eliminate if necessary.

Hope this helps. Take care and please ask any follow up questions, if any.

I understand your concerns and I will try my best to answer all your questions and help you come to a solution.

There is a very sensitive and specific test for the herpes simplex virus that is not normally done on skin lesions. This involves molecular testing with polymerase chain reaction (PCR) for genetic material of virus in the lesions. This test can not only tell if you have herpes, but it can also tell the difference between type 1 and 2 (although most genital lesions are type 2). The samples should be taken during outbreaks for increased chances of detection if present. If the test is negative, you can be assured that your lesions are not herpes related.

Having said that, you have mentioned that you have already taken the blood test, which was negative. Furthermore, your doctors have relayed that there is nothing to swab and the lesions do not resemble that of typical herpes lesions. You may want to consider the possibility of another diagnosis. You mentioned that you were screened for other STD's which came back negative. There is a possibility that either there is another infection, such as candidiasis (judging from the lesions you have described), or it could be an inflammatory or non-infectious cause such as lichen nitidus, hirsuties papillaris gentalis, or Fordyces spots.

In the latter, the non-infectious causes, the lesions are usually self-limited and do not require any treatment. Fordyces spots are normal and present in 80% of the male population and are completely harmless. These would not spread to sexual partners or anyone through kissing, to answer your question. If you are not experiencing any other symptoms such as itching, inflammation, redness, painful sex, fever, or spread of lesions to other areas of the body or other persons (thus far) ~ then most likely it is not an infectious cause. This may be the reason why the physicians who examined your lesions did not treat you for any infection with antibiotics or further treatment. Here is what I suggest:

Make an appointment with a reputed dermatologist. If you haven't already done so, get tested for other possible infections of the penis, such as candidiasis (penile thrush), molluscum contagiosum, human papillomavirus. Once infection is ruled out, you can be confident that the lesions are not contagious. You may require a biopsy of the lesions to determine an accurate diagnosis.
Make an appointment with an allergy specialist as well. Do pin prick allergy testing to determine if you are allergic to something specific causing you the rash to flare up on your penis.

In the meantime, hydrocortisone creams can help you with the outbreaks in reducing the bumps and speeding recovery. Use as needed, only during outbreaks.
As far as a vaccine is concerned, it is difficult to tell without an accurate diagnosis, and there aren't vaccines available for most of the above mentioned conditions.

I hope this helps. Take care