Interested and worried.

[interestedandworried]

Good evening Doctor.

I hope you can help me and provide me with some information.

I just want to now about:

1. Donovanosis(Granuloma inguinale) - does this always cause small, painless nodules (which appear after about 10–40 days of the contact with the bacteria) which burst , creating open, fleshy, oozing lesions? I read that the infection spreads, mutilating the infected tissue and the infection will continue to destroy the tissue until treated. Correct? So with no symptoms ever, I should not worry about it?

2. lymphogranuloma venereum - again, does this always cause symptoms such as inflammation of the lymph glands and Lymphangitis? and so in the absecne of the symptoms, not to worry?. As I am aware, the lymph nodes get bigger -  would be obvious if one had this infection after a year from my last exposure? I had 1g of azithromycin in October as well as 400 mg of cefixime, - would that have cured any of the bacteria which causes lymphogranuloma venereum (i believe it to be clymidia).

3. Chancroid - no ulcers ever developed. Would an ulcer/ulcers always develop? and so no ulcers = no Chancroid infection? In any event, i believe 1g of azithromycin cures a Chancroid infection. correct?

4. Scabies - From my knowledge it appears that if one were to have scabies then one would be extremely itchy and would have a rash. Would one always develop symptoms of scabies? I have never had that in my pubic area, and so after a year, can I discount this?

5. Public Lice (Pediculus pubis) - again, never had an severe itching before and cannot see any black dots down there . would one always have symptoms, and so after a year without symptoms, I shouldn't worry?

Thanks

[interestedandworried]

Thank you Dr.


Appreciate it. :)

[H. Hunter Handsfield, M.D.]

Your research has been good.  The answer to all 6 questions is correct or yes.

[interestedandworried]

Hi Dr. I have been checked for gin, chalmyda and syphillis and HIV - a ll thankfully negative.

I do not have any itching whatsoever.
I live in Great Britain. I would like you to answer these questions if possible for my own assurance.

1. So in terms of donovanosis - it always produces symptoms and with no symptoms ever, I am not at risk. Is this correct?

2. In terms of LGV - again always causes symptoms, i.e. lymph node inflammation in the joint and Lymphangitis - so no symptoms = no LGV? True?

3. and for rectal LGV that wouldn't apply, as I have not had unprotected anal sex where I was the receptive partner, so rectal LGV doesn't apply. True?

4. Chancroid would again produce symptoms and as I have no ulcers, I wouldn't have chancroid. Correct? But 1g azithro cures it. True as well?

5. Yes, I have never had itching or anything like that whatsoever. So I can discount scabies and public lice altogether. Correct?

6. I also have a little ulcer in the bottom of my inner lip between my lower inner lip and the gums where my teeth are (but more on the actual inner lip), - its very small and round. Am I right to say that, herpes doesn't really appear in the mouth and when it does, it would be clusters of blisters and ulcers, so a single little ulcer is not going to be herpetic. Correct? Just want to make sure so I can perform cunninglngus on my partner.

Thanks

[H. Hunter Handsfield, M.D.]

To be maximally safe, despite your safe sexual exposures with men, it would be reasonable for you to visit your local health department STD clinic, or other doctor or clinic, for periodic testing for common STDs (gonorrhea, chlamydia, syphilis) and HIV.  Once a year would be about right.

[H. Hunter Handsfield, M.D.]

Welcome to the forum.  I'll try to help.

Assuming you are in the US or other industrialized country, it is exceedingly unlikely you were exposed to or acquired donovanosis or chancroid; as I recall, no cases of either one have been reported in this country for several years.  If there were any, it was a couple each year, in people who acquired them in other coungries but were diagnosed here.  I'm pretty certain the same is true for almost all industrialized countries. LGV isn't quite as rare, but it's close.  The handful of cases (under a couple hundred annually) are rectal infections in gay men; the classic version -- lymph node inflammation in the groin, with or without a genital ulcer -- is as rare as the other two.

1-3) Your description of symptoms is more or less correct.  Some of the details don't fit, but given that you're not at risk -- and that everyone with such symptoms has other causes -- it isn't worth any time or energy (yours or mine) go respond in any more detail.

4) The main symptoms of scabies indeed is an intensely itchy localized rash.  The most commonly involved sites are the hands, elbows, around the waste, and often the genital area.  Itching doesn't generally start until 2 weeks or more after infestation.  Although it can be sexually acquired, scabies isn't an STD in the usual sense, and most cases are not acquired sexually.

5) Pubic lice also cause itching, primarily in the pubic area.  Although the lice or their nits (eggs) attached to pubic hair can be missed on casual inspection, it's easy to find them when looking closely.  It would be very unusual for symptoms to not start until a year after infestation.

If you have genital area itching, the odds are it's not an STD.  In general, this is an uncommon STD symptom -- but any number of non-STD skin conditions could be responsible.  Visit a doctor or clinic if you have such symptoms or otherwise remain concerned.

Regards--  HHH, MD

[interestedandworried]

Meant to say:

I have a GF, however, have dabbled outside my relationship with men. The last time this happened was over 14 months ago. All anal penetrative sex with the men was condom protected (roughly 8 men give or take) and I was on top. I have had unprotected oral sex performed on me(20-30times) by 10 men, and I have given it (10 times maximum to 8 people)