The elderly man was extremely nervous. He discovered numerous small blisters on his buttocks, scrotum, and prepuce, which were both itchy and painful. Recalling a high-risk sexual encounter two weeks prior, he became intensely anxious, fearing he had contracted genital herpes, and rushed to seek medical attention.

Despite his age and life experiences, the man was able to express himself very clearly. It turned out that two weeks ago, he had a single instance of unprotected sexual intercourse with a middle-aged woman he knew. The woman had assured him she was healthy, noting that she had recently undergone surgery for uterine fibroids, during which the hospital screened her for sexually transmitted diseases; her results for syphilis and HIV were negative, and she had never presented with any lesions. Perhaps due to the influence of alcohol, or perhaps because there was no concern regarding pregnancy, no safety precautions were taken.

However, a week ago, the elderly gentleman began feeling intermittent shooting pains in his groin and upper thigh. He didn't take it seriously at first, as it wasn't severe and he assumed it was a lumbar spine issue. However, three days ago, he discovered erythema, papules, and blisters on his buttocks, scrotum, and prepuce. After searching online, the first result that popped up was genital herpes. Upon learning it was a sexually transmitted disease (STD), he became extremely fearful. Although he questioned the woman and she explicitly stated she never had genital herpes or any STD, the gentleman remained very anxious and rushed to seek medical attention.

After examining the rash, I told him, "This is not genital herpes. Notice that your erythema, papules, and blisters are all located on one side of your body. This is herpes zoster (shingles). It occurred because you have been overworked lately, and combined with your age, the latent varicella-zoster virus in your body reactivated, resulting in this rash accompanied by significant pain. Genital herpes typically presents as a single cluster of erythema, papules, and blisters, rather than a dermatomal, band-like distribution like yours. Therefore, this is herpes zoster, not genital herpes."

The gentleman was greatly relieved. I prescribed antiviral medications, neurotrophic agents, analgesics, and medications to prevent secondary infection. I also provided instructions on precautions, including getting plenty of rest and minimizing walking to avoid rupturing the blisters, and advised him to return to my clinic for a follow-up appointment after some time.

This is a case from my outpatient clinic several years ago. It serves as a reminder that rashes appearing in private areas are not necessarily STDs; they could be other common skin conditions. When a rash appears in the genital area, do not panic. Seek timely medical attention at a dermatology department in a regular hospital, or consult a dermatologist online by providing clear photographs of the affected area.

By the way, for individuals over the age of 50 who have never had shingles or are concerned about contracting it, it is highly recommended to receive the recombinant zoster vaccine. Its protective efficacy against herpes zoster reaches approximately 97%. Particularly for those with chronic diseases or compromised immune systems, if finances allow, my personal recommendation is to get vaccinated against shingles, as postherpetic neuralgia can be incredibly stubborn and persistent.