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Mollusum Contagiosum? Yeast Infection? Or herpes...?

Dear Doctors, l

Day 1: Boyfriend and I have unprotected sex (we have been together for 7 months and have both been tested, no STDs) Day 2: I notice I have a yeast  infection. Day 3: Yeast infection is cured. Day 4: Hurts to urinate for boyfriend. Get's tested for UTI, negative. Day 5: Still hurts to urinate, notices small, circular dark red "scabs" on his penis. Get them looked at, doctor says it's not herpes and tells us not to worry. Tells him that the pain while urinating will go away on it's own. Day 5: Spots are still there and have not changed. Go see family doctor. She also says it doesn't look like herpes and kind of looks like bites. Sends boyfriend to the BC Centre of Disease Control. Two doctors examine him and both say it looks like molluscum contagiosum. Test the spots, his urethra and blood for herpes anyways. Also don't know why it hurts for him to urinate. Results come in on June 22.

1.  If this were to be herpes, how could have this happened and where could have this come from? My boyfriend never noticed any blisters, just small, circular painless scabs the day after it started to hurt to urinate.

2. What could be causing the painful urination?

3. We have been having continuous unprotected sex for 7 months. Why is something showing up now?

4. My boyfriend's mom told me that as a child, he would get cold sores, so this couldn't be from unprotected oral sex. Can it?

5. If it turns out to be molluscum contagiosum, where could this have come from? It seems like a bit of a coincidence that spots would show up/his painful urination after I had a yeast infection.

6. What are the signs and symptoms of a penile yeast infection?
11 Responses
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239123 tn?1267647614
MEDICAL PROFESSIONAL
Half of all adults in the US have HSV-1, mostly oral infection, often acquired in childhood.  Most of them have no recollection of cold sores or other symptoms.  I don't know the data for Canada, but I assume it is similar.  If you are among those with asymptomatic oral infection, he could have acquired his infection from you by oral sex.  It is less likely that you have genital HSV-1 and he was infected by genital sex, but I can't rule it out.  Or perhaps he caught his genital infection somewhere else, maybe years ago -- and now has had a recurrent outbreak.

Recurrent herpes isn't common with genital HSV-1, so in the event he is in a new relationship someday, there may not be much risk of transmission.

The BCCDC folks who have diagnosed him will be much better able than I am to sort out when and where he might have been infected.  Or, as I suggested above, he could seek care at the UBC herpes/infectious diseases clinic.  But we've gone as far as possible in this forum, so I won't have anything more to say.
Helpful - 0
Avatar universal
Doctor,

My boyfriend has been diagnosed with genital HSV-1. How could he have contracted this? I have never had a cold sore in my life and I have never had a genital outbreak of HSV. Where do we go from here? Can you please give me some information.

He is of course traumatized by this situation. His main worry is that if we were to break up, will he have to inform future/potential partners? What will he have to do?
Helpful - 0
239123 tn?1267647614
MEDICAL PROFESSIONAL
You're overthinking it.  These factors don't giove clues one way or another.  In any case, direct exam by BCCDC is far more accurate in judging this than I (or any distant online expert) can possibly be.  Therefore, there isn't much point in continuing the discuss here until and unless a definite diagnosis is made.  Until then I won't have anything more to say.
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Avatar universal
1) My boyfriend noticed a spot at the very bottomunderneath his penis/at the top of his scrotum. It's not new. It looks like the others. Is this is common spot for herpes to occur?

2) If my boyfriend were to pick one of the spots and it bled, would this suggest herpes?
Helpful - 0
239123 tn?1267647614
MEDICAL PROFESSIONAL
1) No particular order.  Either can be first.
2) Yes. Initial herpes typically lasts 10-20 days. This is why he should be taking an anti-herpes drug. When you wait until the diagnosis is confirmed, it's usually to late to make much difference.
3) Perhaps more than one thing is going on.  Otherwise I can't comment on this.

Be clear:  I do not know that herpes is the problem here.  You're just going to have to work with your doctors as the lab tests become available.
Helpful - 0
Avatar universal
I have a couple of other questions regarding herpes:

1) Would painful urination come first, or noticeable sores?

2) It's been 5/6 days and it still hurts for my boyfriend to pee. Does herpes in the urethra last this long?

3) We noticed the spots the day after it hurt for him to urinate. They are small, dark red spots. The doctors at BCCDC said that whatever it is, it's in the healing process. Doesn't it take 7-14 days for herpes to heal w/o medication? Is it possible for herpes to heal/scab on Day 2 of infection?
Helpful - 0
Avatar universal
Thank you very much Doctor for your helpful information. I will try to get this off my mind until we receive the results on June 22nd. Whatever the results the may be, I think I will get myself tested as well, just to be sure. Before our relationship, I had a blood test for HSV-2, which was negative. Also had a full STD scan. This all occurred in September. We started dating in November. If this were to be herpes, I would think it would be HSV-1, not 2. Who knows? Maybe his mom is mistaken and he hasn't had cold sores in the past. He could have contracted this from me during oral sex, although I haven't had any active cold sores recently. Thanks again Doctor for the information. I will keep you posted with the results in exactly a week.
Helpful - 0
239123 tn?1267647614
MEDICAL PROFESSIONAL
Your description indeed suggests you really had a yeast infection.  But that doesn't mean you don't also have asymptomatic herpes.

As to "how this could have happened" (if you have herpes), it really isn't very mysterious.  Your situation isn't at all unusual.  Just the opposite; this is exactly how herpes first shows up in relationship.  Most new genital herpes are transmitted by a partner who is asymptomatic and doesn't know they have HSV, often many months into a relationship.  I could use your story to teach medical students and residents what to expect in their own patients.

There always could be more than one problem going on.  Maybe there is both MC and herpes; or both of those plus a yeast infection.

And still, it isn't yet certain herpes is a problem at all.  I suggest you stop speculating and try to stop worrying while you wait for the test results.  And take comfort that your partner isn't so concerned about all this.
Helpful - 0
Avatar universal
I honestly don't see how this could have happened, Doctor. I am worried sick. I think I'm more worried than he is. Doctor, I am positive that it was a yeast infection. I had no sores/cuts/lesions present. Only the "cottage cheese like" discharge. And my boyfriend would never cheat on me. He's not that kind of guy.

Waiting a week for the results is so nerve racking. That's why I posted our story on here. We have looked at pictures of herpes lesions together and his lesions look nothing like what we have seen. The spots are also painless, which I believe is a good sign. He has also noticed nothing new. I guess all we can do it wait for the results, which is currently driving me crazy.

The second doctor that examined him at BCCDC thought it was MC because he noticed an MC like lesion near his pubic area. He said it was possible that he could have touched the lesion and then his penis, which could have caused his penile lesions. Also, if an MC lesion were to be at the top of his penis, could this cause painful urination?

Overall, it doesn't matter to me what the results are. I love him too much, and I'm not going to let an impersonal virus interfere with our relationship. I just hope he feels the same way.
Helpful - 0
239123 tn?1267647614
MEDICAL PROFESSIONAL
Sorry, I missed the fact that your partner's penile lesions have already been tested at BCCDC for HSV.  (They probably would not have done that unless they thought herpes is a real possibility.)  Wait on those test results before seeking another opinion.  If the results are negative, then blood testing probably will be warranted.

In the meantime, most STD and herpes experts agree that in situations like this, the patient ought to be treated with an anti-herpes drug, without waiting for the lab test results.  Treatment is far more effective when started early, and the drugs have no side effects, so there is no reason not to get started.
Helpful - 0
239123 tn?1267647614
MEDICAL PROFESSIONAL
Welcome to the STD forum.  I'll try to help.  Despite two doctors' opinions that this isn't herpes, I think that remains a real possibility.

However, even the world's top herpes experts often have trouble making an accurate diagnosis based only on symptoms and examination, and your description is suspicious for herpes, especially with both penile "bug bite" skin lesionw, with scabs, and painful urination.  Also, I have to wonder whether your apparent yeast infection actually was a herpes outbreak. I'm not making any sort of definite diagnosis.  All things considered, I would put the chance this is herpes in the 50:50 range.

1) Painful urination is common with initial genital herpes but rarely occurs during recurrent outbreaks. If this is herpes, it's probably your partner's first infection, which probably would mean you are infected and he caught it from you.  However, if he had other partners in the 2 weeks before his symptoms started, that would be another likely source.

2) See above.

3) Herpes is transmitted only intermittently.  It is very common for it to first appear several months into a realtionship, sometimes many years.

4) People are immune, or at least highly resistant, to catching the same HSV type more than once.  If his mom's diagnosis is correct, the current problem probably isn't HSV-1.  (You might ask her whether she understands the difference between cold sores and other oral lesions, like canker sores.  The latter occur inside the mouth, herpes on the outside.)

5) This doesn't sound at all like MC, which doesn't cause either scabs or painful urination.

6) Penile yeast infections are uncommon.  When it happens, mostly it is a diffuse red rash, not one with separate red bumps and sores. Painful urination is uncommon.

I recommend that you and your partner return (together) to BCCDC ASAP.  Alternatively, call the division of infectious diseases at UBC.  At one time, UBC was one of the world leaders in genital herpes research and clinical care, and their clinic probably retains excellent expertise in HSV infections.  If the clinic agrees herpes is a possibility and your boyfriend's penile lesions are continuing, i.e. not dry and healing, they should be tested for HSV by culture or PCR and both of you should have blood tests for HSV-1 and HSV-2.  Finally, if his painful urination is continuing, or fresh penile sores continue to appear, it might be good if he were to be taking one of the anti-herpes drugs (valacyclovir, acyclovir, or famciclovir).

I'll be interested in follow-up information after further evaluation for herpes and other possibilities.  Please let me know what turns up.  In the meantime, I hope this helps.

Regards--  HHH, MD
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