Transient Penis Rash and Burning

[sdr]

Around 16 weeks ago I received manual stimulation from a sex worker (nothing else - hand to genital only).  I felt very guilty and ashamed about this, so 3 days later I went to my local STD clinic for a checkup.  They tested me for STDs except Herpes and Genital warts - (C/G/S/HIV/NSU) everything negative.  Over the next week I had some pain/irritation a little inside my urethra (approx where the test swab had been taken) Also, over that first week I washed my penis will all kinds of soaps and it became quite dry/irritated.  

After a week of the urethral pain I returned to the clinic.  They said it was normal to have some irritation after the test, however to be sure they tested me again - negative.

Reassured by the clinic, I began having unprotected sex again with my regular partner (5 years together).  Over the next month the urethral pain did not go away, and I noticed I was getting a transient, blotchy rash on my penis glad and underside of my foreskin. The rash would appear in a different location/s once every 2 weeks or so, then disappear after a few days. The head of my penis felt raw and I had a burning sensation around the penis gland almost all the time. I also had an itchy scrotum, however the skin looked normal.

I went to another STD clinic and they tested me a 3rd time - negative.  By chance, I had the rash when I saw the nurse and he said it looked like thrush and I should use canesten cream to clear it up.  When I mentioned this to my regular partner, she said she was itchy downstairs and the symptoms were the same as thrush she had a couple of years ago.

I began to wash my penis only with water.  The canesten cream soothed the burning for the first couple of days, after which the burning became much worse, particularly at the urethra tip.  I also tried the Canesten oral tablet which did nothing.  After I discontinued the cream the burning reverted to its previous  (lower) level over a week or so.

At the 2 month mark I went to my family doctor and she told me that I should go back to the STD clinic. I felt it was pointless going back, so I walked into an accident and emergency hospital desperate for help.  I saw a doctor who tested me for a urethra infection (negative) and gave me Doxycycline & Metronidazole (I think that was it) to take for a week.  This resolved the pain inside the tip of my urethra, however the burning on the gland remained.

In the month since then the blotchy rash and burning have continued.  My urethra tip is particularly sore.  I have also continued to have general itching around my scrotum and penis area.  For the last 3 days I have been applying Nizoral cream.  This has fixed the itching on my scrotum and penis, but not the burning on the glad. I am also applying Aqueous cream which helps soothe the burning.

It seems logical that the problem is unrelated to my 'hand job', however the apparent coincidence is not helping my state of mind.

Your advise would be greatly appreciated

[Alan Rockoff, MD]

My diagnosis is guilt.  The coincidence of symptoms is probably not so much coincidental as related to your examining your penis with greater than usual care, and perhaps rubbing the area in anxious self-examination.  I very much doubt yeast (not usually transmitted, by the way) or any STD, which have been looked into with what I would judge sufficient diligence.  I can't think of many things you could have picked up after the kind of contact you describe, in any case.  My advice is to ignore the residual symptoms, not to be concerned with infecting your partner, and to apply nothing more than bland, non-medicated emollients like petroleum jelly.  You should be fine.

Best.

Dr. Rockoff

[Asiapanic]

Probably nothing came of the hand job, but if that contact worries you, going after two months from the time of contact is good advice because then the blood work is more reliable.  It takes time for an infected body to produce enough antibodies etc. to show up in the tests.  

Regarding the pains and so forth - You might have a physical cause with the thrush and all the varied treatments you have been trying, but guilt and fear and so forth can make a person lose a sense of perspective quickly, and worsen or maybe even "create" a symptom or condition.  That's what seemed to happen with me.  

I have had a guilt-inducing hand job, and to my shame more than one -- and many years before that, once, a blow job.  Afterwards, I was certain I was going to get an STD to "punish" me for being so careless with my health and for playing around outside of my marriage.  All tests but herpes were done after the blow job, and everything was negative.  I got married, and I have not considered getting oral sex outside marriage again.  But several years after marriage my wife and I weren't getting together hardly at all, so one time I was drunk and I went out looking for a strip club and some woman offered to give me a hand job and I agreed.  The next day I freaked out, ran to the clinic, and they said - You're probably fine, but if you want to be certain, you need a test, and for the test to be certain, you need to come back in two months and do it then.  

The horrible thing was - Around about the 2 or 3 month mark I would find myself drunk and at the massage parlor again.  The cycle continued like that for about a year.  Awful.  It was like I was out of control.  

Here's the thing: I didn't have a rash, but I became really super sensitive about my penis and about my skin.  The whole time I was waiting for these tests every little twinge made me think I had herpes or AIDS or something and had already given it to my wife.  I noticed a cyst on my penis one time - this was proof I had something horrible.  But it was removed and labeled benign.  I noticed a little split in the skin in my eyelids or near my mouth, and instead of thinking: I'm chapped, it's dry, etc., I'd think: fissures = herpes!  I'd keep thinking, it was dark, I didn't look closely at her hands, I don't know that the towel was clean, etc.  It seems though that these "symptoms" of STDs weren't STDs after all, just other things that were going on.  

The worst one was that I felt like I always had to go to the bathroom, there'd be this drip-tingle sensation, like I was incontinent.  I'd get to the bathroom and hardly anything would come out - no surprise, because I was in there all the time.  I went to urologists and everything.  At one point I was so sensitive down there that I could barely walk.  Over time and with many reassurances (including urine and blood exams), the drip-sensation finally went away.  

I still get really worked up whenever I see some new spot or feel some different twinge on any part of my skin, particularly groin, hands, and face.  I find little bumps I never noticed on my hand; I get this little tickle-itch on my belt-line in what seems to be the same place all the time -- all of this can set me into a fearful state.  But as I slowly get more balanced in my thinking and gain more appreciation for the variation of skin appearances and feelings within the normal "range" I can return from these fear binges more quickly.  

I pray you get some good, trustworthy medical advice - that is so important - but that once you do you can let yourself off the hook with a simple "never again" and allow your mind to help you heal rather than help you hurt.  Good luck.

[sdr]

Thanks for your kind and thoughtful reply.  When it first happened I felt terrible - I made myself sick with worry.  I have been seeing a counsellor who has helped me understand that it was a mistake and I can choose to learn from it or let it fester.  For the first month or two I panicked constantly that I had something sinister (after all I deserved it).  However at the 4 month mark, with florid rashes & considerable discomfort everyday, I am in no doubt it is not in my head.

At the same time I am trying not to let paranoia take hold.  Every clinic staff member has told me that the risk was very small, if not zero.  Also I have been tested for everything except herpes and warts - and my symptoms do not indicate these.  The evidence suggests it is not related. I just long for the day when it is all normal again.

Again thanks for the thoughtful comments.

[Asiapanic]

Great.  It sounds like you managed the emotional stuff better than I did!  With your symptoms, then your attitude seems totally appropriate.  I hope the Doctor's advice helps get the physical problem cleaned up.  Good luck!