I have just returned from my second trip to the hospital here and have a better idea of what I am dealing with. The doctor´s assumptions were correct and I developed ulcers on my rear, right where the thigh meets my bum. They are the result of riding the bike and they got infected with apparently a few types of bacteria, one of which was breaking down my skin and causing the ulcers to grow and become very painful. This was also the reason for my fatigue and dehydration.
Standing with your pants around your ankles in a room while a stranger (and an attractive young female doctor at that, although I guess that is better than a young male doctor) pokes around your nether regions is not the most comfortable of experiences. The actual treating of the legions is no fun either and neither of these experiences was any better on the second go around, and I am sure wont be any more pleasant on the third and fourth. However, I have to say, the doctor is great, she really helped to make me feel comfortable in a really unpleasant situation.
I talked with the doctor at length about my trip, how I was going about it and what I had to do to prevent things like this from occurring in the future. She was really empathetic, and felt so bad for me that she didn´t even charge me for the second visit which really blew me away. That is not something you would ever expect to happen in the states.
Basically, she told me that to continue, I would have to make some fairly drastic changes. I would have to ride less miles per day, ride at an easier pace, take more frequent and longer breaks and avoid riding in tropical regions as well as applying baby cream to my rear end on hot or humid days to reduce friction. She said I would also have to sleep indoors more often and bathe more frequently, and less often in rivers, lakes, or streams (which obviously I would like to do but camping you don't have a choice). The ulcers are brought on by heat, moisture and friction, and then are infected by bacteria which live in water, especially muddy water, and can be anywhere.
I asked her what the likelihood of experiencing another outbreak of this would be if I continued on the way I had been and she said there was a chance it would not occur again but that was very slim, and that I should assume that it would happen at least once more, possibly several times.
She also stated that I was lucky that it hit me hard in Costa Rica as the medical care here is excellent. She said that here, or in Panama I would have been OK (although she said treatment would have been much more expensive in Panama) but if it were to have hit me in Nicaragua or Honduras, I would have been in deep trouble as they are unable to treat this type of thing.
Considering that the vast majority of my trip goes through tropical areas, I would have to dramatically change things. Basically, I would have to go slower and spend more money per day by quite a bit in order to ensure I don't go through something like this again, possibly in a place where there is no way of treating it. I would also have to try and avoid tropical areas as much as possible, which unfortunately covers most of my trip.
Obviously this is not the best news, so I am going to take a night to sleep on it and weigh all of the factors and make my decision as to what I am going to do tomorrow.