Possible causes of irritation?

[Deleted51909]

Dear Dr. Handsfield,

14 days ago I had unprotected oral sex and partially unprotected vaginal sex (the condom broke, but I stopped immediately). After a week, I found a couple of small, flat red spots on the head of my penis that I'm pretty sure were not there before. There was also one that was there before, which I have had for years, but seems to have grown to about the size of a dime. Other symptoms: fever, swollen glads under jaw, and ,at times, intense, burning at the head of my penis.  I went to a std clinic on the tenth day after exposure, and was told that the spots did not look like herpes because they were not blistered or full of fluid. I had a blood and urine test while at the clinic, and must wait another week for that. The doctor thought that the spots might be due to a fungal infection, and prescribed 'canesten,' which has not alleviated any of the symptoms during the 3-4 days I have used it.

From what I have read in your other posts, it seems that I am most a risk for contracting herpes or NGU from the oral sex. I'm not quite sure what to think about the broken condem, since the exposure was extremely brief (although I did ejaculate just as the condom broke).

Of course, I am most worried about stds, and I wonder if the buring might be a symptom of NGU. Other possibilities I have considered are a yeast infection or  UTI ( I have a long standing problem with urination; I can't completely empty my bladder at once), and excessive masturbation over an extended period of time.

Can you make any sense of this?

[Edward W Hook, MD]

Where on the West Coast?  Here at Medhelp we try hard not to contradict our clients' personal physicians but I have to say, I have trouble following the logic in the approach being taken to your problem.  I find the idea that you cannot be tested for NGU at public STD clinics troublesome. You might also describe your dilemma to the STD Community site - someone there may be able to help you with a referral as well

The test for NGU is looking for increased white blood cells on the first part of a urine specimen or on a swab taken from the penis..  A discharge does not need to be present to make the diagnosis and with all due respect to the doctor you saw, he should still be willing to do the test.

Regarding the therapy offered, this is essentially a therapeutic trial in which the doctor is either giving you antibiotics to placate you or because he doesn't know what is going on and wants to try "something".  This too is troublesome.   Personally, I think you have lived with this a while and need to know what is being treated rather than blindly trying something.  EWH

[Deleted51909]

Thanks again - I've gone to a GP about the lesion, but he says that he cannot tell whether it is genital herpes because there is nothing to swab (nor has there been, even though there is clearly now a lesion), and declined to test for NGU because there is no discharge.  

He has sent me to a dermatologist and given me a choice of anti-herpes drugs, or anti-biotics (400mg of Cefixime/Suprax and 1gm stat of Zithromax) for the aggravating 'infected' feeling that I continue to experience in the head of my penis.

Can I please ask what you think of this prescription?  I have been examining myself a lot, but the pain I am feeling is quite real; but since I have not been diagnosed with any certainty, it is difficult to know what medication (if any) I should be taking.

[Edward W Hook, MD]

Sounds like whomever tested you did not test you fro nongonococcal urethritis.  NGU is tested for by looking for increased numbers of white blood cells in one's urine or on a swab test.  The tests are most accurate if you have not urinated for at least an hour before the specimen is taken and, if a urine test is used, it is importnat to send the very first part of the urine as you void, not a midstream specimen.  In CA the STD clinics are superb and that is where I would go. If that doesn't work out your GP might be able to help as well although the folks at the STD clinic are probably more experienced in this area.

I cannot comment on the red spot except that it sounds as though you have been examining yourself a lot.  This is turn may be causing the red spot.  It would be unusual for herpes to show up more than 14 days following an exposure.  Again, the STD clinic folks can probably be of help here.  EWH

[Deleted51909]

Thank you for you response, Dr. Hook.

I have just called the STD clinic I used where I live on the West coast, and they tell me that the urine test I took at 10 days will show the presence (if any) of Clamydia or Gonorrhea, and that the blood test is for Syphilis. I suppose this means that I must go to a GP to test for NGU or other penile infections. What sort of test should I ask for? Just a urine exam, or a swab of some kind?

The clinic also told me that I can be confident that the test results after reliable when taken 10 days from exposure. Would you agree? I thought that 14 days was the norm.

I woke up this morning with sore at the bottom of the head of my penis, where the skin is naturally quite dark red. I have suspected a little spot there for the past week, but this morning it is quite distinguishable from the surrounding skin by its bright red colour, about 1/2 inch in diameter. It is not (yet) raised or blistered, as far as I can tell. What are the chances of developing the overt symptoms of genital herpes after 14 days? Again, the clinic told me that any red spots that had not become raised, blistered and full of fluid after 10 days are unlikely to be genital herpes. Is this true?

I should say that the 'burning' I feel is not just with urination. It is a pretty constant feeling in the head of my penis. Often it feels like burning, but it is hard to describe. I would just say that it feels infected.

Thanks again.

[Edward W Hook, MD]

Dr. Handsfield and I share the forum.  You got me.  FYI, the reason we share the forum is because we have worked together for nearly 30 years and while our verbiage styles vary, we have never disagreed on management strategies or advice to clients.  I'll try to help you sort this out but I also have to say that you are doing a pretty good job on your own.  Let me provide a few comments:

1.  A broken condom means your sex was unprotected.  While it makes good sense that the briefer the exposure the less likely one is to acquire infection, as I suspect you can imagine, there are no studies to help us sort out the contribution of the "time of exposure" varible to STD risk.

2.  You say nothing about your partner and their risk but it is also worth pointing out that most people, even "high risk" partners do not have infection.

3.  The skin/rash/red spot symptoms you suggest are not consistent with any true STDs, i.e. GC, chlamydia, NGU, herpes, syphilis, etc.  As you point out, they could be suggestive of a fungal skin infection which, although not a "classical" STD, nor transmissible in the classical STD sense, can be acquired during sex. The penis receives a lot of blood flow and, as a result the size of such rashes can appear to chance with time. Topical therapy is a reasonable way to start.

4.  The burning on urination you mention does concern me for NGU or other sort of urethritis.  Since your penile sex was unprotected, you could have chlamydia or other problems.  I'm surprised to hear it takes so long for test results to come back.  I would check after 5 days to find out your results and, if the burning persists, even if your initial tests are negative, I would seek a re-evaluation,  making sure to not urinate for at least an hour before you are seen (this improves the accuracy of some tests).

5.  Finally, the fever, swollen glands under the neck are not particularly suggestive of STD per se and could be just about anything including a community acquired respiratory tract infection unrelated to your sexual exposure..

Hope these comments help.  Please let us know what your tests show and what happens.  EWH