Brief Answer: Kindly upload details & high resolution pictures Detailed Answer: Hi, Welcome and thanks for posting your to the forum. After reading your query with diligence and analyzing the complete report with correlation to your clinical symptoms I can make out that you have the problem of red itchy lesion on glans occurring monthly which got healed with Tenovate M and now are not healing with the same also. Presently these are occurring more frequently than once per month and are not getting healed despite of using Tenovate M. You had gone for herpes and HIV tests- amongst which HSV-2 IgG came positive in NOV 2012. Now after getting all the information as above I first want to confirm whether the recurrent red spots on glance are related to herpes genitalis (HSV-2) or not. To tell you medically - Herpes lesions manifest itself as small vesicles (fluid filled blisters) which remains for just a day or two and then forms ulcers which are quite painful. These ulcers then heal in next 5-7 days. To begin with also these vesicles are quite painful and itchy with discomfort and once the vesicles burst in a day or two then the ulcers which are formed are quite painful for next 4-5 days. So the symptoms can never go unnoticed. It is typically seen as "fluid filled multiple vesicles present closely in a grouped manner" which you can see on net as a ready reference. There are two types of herpes – one is on lips which is caused by HSV-1 and the other is on genital area caused by HSV-2. Accordingly there are antibodies for these i.e IgM denoting recent infection (less than few weeks to months) and Ig G denoting past infection (more than few months). Many a times, we see that IgG is positive in cases where there is no clinical evidence of disease is present and shows that there had been subclinical episode was present. So you can get the important part of herpes which can be differentiated very easily. I can make out that previously you got the red spots rash almost every month and now you are getting it even less than in a months time. For herpes it is very unlikely to get such frequent red spots or rash. At the maximum we see a close to 6-9 episodes per month or atlest a gap of minimum of 1 month. Seconldy hereps lesion never get healed by applying Tenovate- M as it contains steroid and antifungal (goes more in favor of fungal infection), herpes being a viral infection so responds only to antiviral treatment. Also it is important to note that you got red spots rather than vesicles or ulcers. Therefore it is very important and quite essential before I confirm it as herpes, You kindly let me know certain important points: 1. The most essential is that can you let me know that whether you can correlate the clinical features (small vesicles or fluid filled grouped blisters or ulcers)of herpes every time you get the red spots. 2. What is the minimum gap you have observed between two episodes? 3. Any history of unprotected intercourse in last two years. If it was, then after how much gap you observed the red rash or any correlation you feel with the unprotected intercourse. 4. Was your condition diagnosed by a dermatologist as Herpes or are you presuming it after the IgG test. 5. Are you applying Tenovate-M under dermatologist’s guidance or as self medication? To tell you about this cream- it contains a strong steroid which makes skin dependent on the application and therefore skin becomes dependent on the steroid ( rash appears as soon as you discontinue the cream and after some times this cream becomes ineffective) I would like to know the exact description of the red spots. Are these scattered or in grouped manner or any ulcers or any discharge. It would be best to send few good resolution pictures of the area so that it can be analyzed best. You have a feature to upload images by yourself at the right side of the query page, please utilize that so that I can answer your queries better. Or else, you can send as an attachment to YYYY@YYYY with the subject as "Attn: Dr. Sanjay Kumar Kanodia). Now for the rest of the queries- presuming you have herpes infection, I answer your queries accordingly: 1) Is there any chance to increase the value of HSV and convert in Both 1&2. There is require reports again? @There is no chance of conversion of HSV-1 and 2. Though belongs to same group but these are different viruses and never get interchanged or converted form 1 to 2 or vice versa. 2) Is there any chance that HSV converted in HIV. @As said earlier HSV and HIV are also totally different viruses and there fore never get interchanged or converted. But both infections can facilitate the entry of other virus in case of unprotected intercourse. 3) I had purchased Valcivir-500 Tab and Acivir-5g Cream through net, should i start to take it and how? is it not harmful. @ Till the time I make it sure that you have exactly herpes infection I would not recommend you to take the antiviral treatment. 4) what is the best way to stop it in increasing and decrease the value. @ There is no way to increase or decrease the value of antibody level of Herpes Ig G or Ig M. There is no correlation of any treatment or antiviral therapy with the level of antibodies. I also add that herpes is one of the simplest of viral infection which we very frequently see in our general practice. It never poses any serious problem in your daily life. It is the anxiety and related depression which makes its impact on higher side. I hope these information will help you. Kindly send these details so that I can help you better. With regards, Dr Sanjay Kumar Kanodia MD ( Dermatology & Sexually Transmitted Diseases)

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Brief Answer: Steroid abuse with dependence; not STD Detailed Answer: Hello young man, Welcome to the forum and thanks for posting all the important information along with the pictures. After thoroughly interpreting the information and analyzing the pictures, let me first and foremost reassure you that your genital condition does not seems to be genital herpes r any other sexually transmitted infection . Rather I make a diagnosis of “steroid abuse and dependence” for the condition. Let me explain you the things simply- As you haven’t had any type of extramarital incidence so the possibility of sexually transmitted infection is totally out whether for herpes or for any other type of sexually transmitted infection. IN herpes or any other sexually transmitted infection, there must be a history of unprotected intercourse. As you gave the history of single relationship and that too with your wife (who is completely clear), so there is no chance of any type of STDs. Now you must be wondering then how and why mollsucum occurred and why there is positive IgG for herpes. For moullucum contagiousum (For which you used salactin lotion)- I very forst doubt that those lesions were mollucum. Even then if those lesions were mollucum, it can be present either due to simple infection or due to sexually transmitted mode. When it is preset on or near to genital region then we suspect of more towards sexually transmitted mode. But as I said it is simple infection which we even see more frequently in children too and can be present due to trivial touching or contact. So in you it got caught by anyone surrounding person having moullscum. Now for the part of positive IgG for herpes- In previous mail also I said that in many persons we find positive IgG for heroes without any clinical sign and symptoms. This is actually is a good sign that you have had exposure to herpes virus and then due to good immunity there was formation of antibodies to herpes virus which are of protective nature. So I totally disagree with any of your thoughts or previous suggestion regarding possibility of herpes present clinically. There must be a clinical sign or symptoms of herpes which I enumerated in previous mail. As there is no evidence of herpes clinically so there is no benefit in taking any anti-viral tablet or Valcivir-500 Tab and Acivir-5g Cream. You do not have any of this kind of sign or symptom and in pictures too I can not make out any type of vesicles or blisters and not even any ulcers too. OK even if it had been present then also herpes is a very simple type of viral infection and very well controllable. It is a very frequently encountered infection which we dermatologist see most often as a sexually transmitted infection. It is totally different from HIV and there is no correlation of herpes with HIV. I am really surprised to know that some of the doctor told you as herpes being more serious than AIDS. It is totally a sarcastic statement and I totally disagree with the statement of the previous doctor. So you relieve your anxiety for any type of STDs including HSV or HIV or any other in your self. Now for the part of present problem of red spots and rashes- It is quite normal and usual process in all of the uncircumcised males. On one side it is due to the thinnest skin present on the penile area and on the other side is due to improper hygiene. The one very important thing to add is that you have applied Tenovate-M as self medications. It contains a strong steroid in it which causes thinning of skin and dependence. So till the time you apply it there had been reduction o redness. But after a period of time it became ineffective and therefore lead to recurrent red spots. I suggest you to not to take anything as self Medication. For the management of the same kindly follow the suggestions below: - Wash your penile area for two times in a day. You can use a mild soap to wash the area. Wash it very gently but properly. As you are uncircumcised so it is quite important to retract your skin fully backwards and then wash the area. - Preferably avoid sexual intercourse for few days. After every sexual intercourse too, wash the area properly. - It is quite very important to check for infection in your partner too. If your partner has white discharge then it is the most common cause of recurrent infection. - Wear cotton undergarments. Change these two times a day. Do not wear any synthetic or tight garments. - Though in general I do not prefer any medications and guide the patient to not apply anything to taper off the side effects of steroids. Many a times here si aggaatio of redness fo rfew days and then as skin gets accustomed to itself then the redness subsides. But some times applying anti-fungal creams such as "Sertaconazole" or "clotrimazole" cream can help. Apply it in a very thin layer so that it should not be visible to the naked eye. A very small amount on the tip of finger ( 1/4 of pea size amount) is suffieicnt for the complete area. - For the itching part you can take antihistamine like "loratadine" two times daily for 5 days and then make it once a day. Overall it is nothing to be worried about. It is a common condition which we see quite often in our day to day practice. With complete treatment of self and partner and with good hygiene maintenance it can be cured very easily. I hope this clears all your doubts. Tell me if you have any further quires. Wish you good health with regards, Dr. Sanjay Kumar Kanodia (MD - Skin & Sexually Transmitted Diseases)

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Brief Answer: Maintain hygiene at your best Detailed Answer: Hi XXXXXXX I am really happy to know that you are quite relaxed now and understood the condition well along with the medical facts regarding the situation. I again reassure you regarding your simple condition. Do maintain good hygiene in yourself and your wife, get proper prophylactic treatment for your partner and be happy and tension free. You may have ups and down in redness, but do not worry about the same. This situation can persist for few months. If still you feel any problem in future then can take guidance from me directly on : bit.ly/drsanjaykanodia If you have any further queries I would be glad to help or if not then can close the query and rate the answer. "My all best wishes for your healthy life ahead" with regards, Dr. Sanjay Kumar Kanodia (MD - Skin & Sexually Transmitted Diseases)

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