A couple questionable spots

[Jeremywray]

Hi doctor thank you so much for your time.
As emberrassing as this is, I must post 2 pictures and ask about them.
http://i61.tinypic.com/bfrjas.jpg%5B/IMG%5D
http://i57.tinypic.com/2mm5t7t.jpg%5B/IMG%5D
Let me explain the first picture. This is the side of my penis close to the pubic area. It is a redish colored spot almost the shape of an M. About 10 weeks ago a red spot appeared and I think went away? 2 weeks after it appeared again as more of an open sore and was a bit painfull and itchy. I was very scared of herpes. The PA at a walk in clinic thought it was a hair follicle and still does after a few more visits 2 months later.
Could it be a hair follicle? In its current state 2 months after getting it, it still itches from the to time and I feel a slight serge in it from time to time. The second image looks like a freckle or blood clot spot. It's flat and I can't feel it but I'm pretty sure it just appeared 5 days ago. I check a lot and never noticed it before.
I must say once in my life over 4 months ago I had unprotected sex with a stranger. Gave her oral and vaginal, so am a bit afraid of stds. Also I'm itchy around nose and eyes quite a bit and a little all over. but don't think I've had any non traditional rashes. I was tested negative for stds including herpes 4 times.
Thank you for your time!

[Jeremywray]

Hello thanks for the response. As I said I was negative for all stds including herpes at 3 months. Knowing this would you say that spot that has bothered me a bit for the past 8 weeks could still be a follicle? Thank you

[Bhupinder Kaur, MD]

Hello,

Thanks for posting your query.

I can understand your concern for the itchy and slightly painful spot on penis and the freckle/ blood clot like spot on penis. I have checked the pictures but they are unfortunately not very clear.

The itchy and painful spot can be due to folliculitis especially if it exuded white discharge. However the possibility of herpes and syphilis should also be ruled out given your history of unprotected vaginal intercourse with a stranger. Syphilis is a sexually transmitted infection caused by Treponema pallidum. The symptoms start with a sore on the penis which turns into an ulcer, which is called a chancre. The chancre heals spontaneously after 4 to 6 weeks.

Hence you need to get investigated for these possibilities also. The only way of ruling it out is by getting yourself tested for genital herpes and syphilis. VRDL, RPR and FTA-ABS for syphilis, culture of the fluid from the blister PCR (polymerase chain reaction) and blood tests to check for antibody levels to the herpes virus are some of the tests which are needed.

The flat spot also need to be examined by a dermatologist. Although it can be a freckle but if it remains the same then possibility of a flat wart should be ruled out. There is currently no FDA-approved test to detect HPV in men. Genital warts can be diagnosed through visual examination of the penis and surrounding areas. Genital warts can be confirmed by biopsy but Sometimes we can use an enhancing technique called acetowhitening. This technique involves the application of 5% acetic acid solution to the area of suspicion for about 5-10 minutes. Infected areas will turn white. But this test is not confirmatory and the best confirmatory test is by biopsy skin.

Till you get these tests done, wear cotton clothes and use mild soaps. If it is due to folliculitis then mild folliculitis usually heals on its own in about 2 weeks. Other than that, you can apply warm compresses and topical antibiotics.

Hope that this information helps and hope that you get better soon.

Wishing you good health.

[Jeremywray]

Sorry, I forgot to mention. That first spot the PA thought was a hair follicle he squeezed white puss from it. I never noticed a white head. Also last week I got a white head 1/2 inch above that spot. Burst in my sleep 2 days later and 5 days later its now in noticeable. Never hurt, maybe slight itch.
Thanks