Burning Sensation - Genitals

[motoriderdc]

About 3 weeks ago I had one-time unprotected sex with a woman, and 2 weeks ago I developed a painless red bump on the tip of my penis. I went to a doctor 1 week ago -- he did a physical examination of the bump and my genitals and said it's "100% not herpes." He said it wasn't worth doing a blood test. However, about 4 days ago I developed some discomfort in my genital area, and over the last several days I've had a burning sensation on/around my genitals. It's not too intense and it seems to come and go, but it's definitely there. It's fairly generalized -- I can't pinpoint the burning to any particular location on the shaft or scrotum. I've had no other symptoms - no bumps, no sores, no swelling, no pain. I've read that when herpes "sheds" it can cause burning, even without producing bumps, so I'm still concerned that I may be infected. I should add that, since I developed the bump and then the discomfort earlier this week, I have been regularly inspecting my genitals and have had a high level of stress about the situation since the sex. So I'm wondering if the burning could be the result of the stress and all the poking and prodding that I've been doing. Thanks.

[Edward W Hook, MD]

Welcome to our Forum.  While AI agree with your doctor that the lesion you describe does not sound like typical herpes and that a blood test would not be helpful in sorting things out, I would have done a HSV PCR to be sure- atypical lesions do occur and the timing is not inconsistent with HSV  It is a widely held misperception that there needs to be a blister or open sore present to perform a HSV PCR or culture- this is incorrect- when due to herpes, dry lesions can certainly give positive results.  

I am confident however that the scrotal burning you have noted is not due to herpes or related to the lesion you describe.  When HSV is present lesions and symptoms occur in the same location, not different part of the genitals.  On the other hand, abnormal sensations that come and go in the setting of a person who is worried about the possiblity of an STI is most often the result of detection of normal sensations that would otherwide go unnoticed.

I think you need a better evaluation of the lesion you describe.  From the fact that it has been present now for several days and not changed much, it is unlikely to be syphilis.  It could be a fungal process, the result of your repeated re-examination (this is surprisingly common) or some other completely unrelated dermatological process.  I doubt that it is HSV

I hope this comment is helpful to you. EWH

[Edward W Hook, MD]

A bump is a lesion.  You are playhing word games.  If the bump, if that is what you wish to call it, is gone now, you should not worry further.  I have nothing more to say. EWH

[motoriderdc]

Thank you for the quick response. Just to clarify a couple things... There has been only one bump -- the one that appeared about a week after sex (there's been no skin issues subsequently that could have resulted from my re-examination).

Also, I wouldn't classify the bump that appeared as "lesion." It never opened or appeared that it might. It was a half of a pea-sized, dry, slightly reddish, slightly raised bump.  When it appeared, it didn't change color or shape much at all and there was no pain or sensitivity. After I went to the doctor, he gave me Clobetasol Propionate cream, and over the course the next several days it began to fade. It's now almost completely gone...just a tiny bit of reddishness.  

Let me know your thoughts, and many thanks.