Trying to rule out STD

6 1/2 weeks ago I had vaginal sex with a stripper, using a condom. 4 days after that I experienced tenderness in the head of my penis, to the point that chaffing against my clothes would cause sharp jabbing pain. I also had sweats and back pain, although it may have been stress. I went to a urologist, who checked for UTI, kidney stones, gonorrhea and chlamydia (all negative). At my follow-up, I had developed a very minor rash on the head of my penis, small red dots in a blotchy pattern. The urologist thought contact dermatitis, and referred me to a dermatologist. A general phys said the same thing (and ran no tests). The dermatologist ran syphilis and allergan tests (both negative). He put me on a cortizone and antifungal cream (in case of yeast infection) for 1 week, during which the tenderness seemed much improved, but the rash did not change. He said he didn't believe it was herpes, but didn't say why, and did no actual testing. He thought it was a contact dermatitis, psiorisis, or eczema.

By this point I was so nervous I went to a testing service and had a complete set of STD tests done (at 28 days after). The tests were HIV (PCR test), syphilis, gonorrhea, chlamydia, hep B, and herpes (via blood tests, both IgG 1 and 2 antibody and IgM antibody). All tests were negative. Several counselors at the testing service claimed both IgG and IgM negative at 28 days was very definitive, but I'm still unsure. It is now 6 weeks later, and I still have the exact same rash, unchanged but less sensitive. Should I consider the testing I've done to be definitive and rule out STDs?

[H. Hunter Handsfield, M.D.]

Relax.  With the test results you have had, you can be 100% sure you didn't acquire any STD from the exposure you describe.  (You had the wrong herpes test; the accurate ones do not test separately for IgG and IgM antibody.  But the inacuracy in the older tests is in understanding what a positive result means; a negative result is clear evidence you don't have herpes.)  Any further testing would be an even greater waste of money than what you (or your medical insurance) have already spent.

Best wishes--  HHH, MD

[dmann411]

Just to clarify my question, what I really want to know is if the IgG and IgM negative result is as definitive at 28 days as this testing service claims. I don't know exactly what type or brand of test was used, but a major national laboratory chain was used to collect samples and do the testing. If there is additional testing I should seek out in order to be 100% sure, what exactly is it, and is there a specific period of time I should wait in order for it to be the most accurate?

Some more information on the rash itself. The dots have never grown or spread, but never went away either. They never blistered, never oozed. I have had no discharges. I have no pain on urination, erection, or ejaculation. I just have tenderness aggregavated by chaffing (but not touching), and occasional dull ache on the penis head even when not rubbing against the clothes. I have developed some occasional itchiness on the scrotum in the past two weeks, but neither I nor my dermatologist were able to identify any rashes on the scrotum.

[Sarah_C]

Was the condom you used lubricated with nonoxyl-9?

That substance is known to cause irritation like that you describe in many people.

[dmann411]

Thanks for your comment. I have no idea and have no way of knowing now. However, I have used nonoxyl-9 in a lubricant tube in the past, and had no reaction to it. So unless what's on the condom is radically different than what's in the tube, I don't think that's it.

[H. Hunter Handsfield, M.D.]

The proper HSV tests are the HerpeSelect test (manufactured by Focus Technologies) and the Biokit HSV-2 test (Biokit Corp), recently reintroduced to the market after the original company went out of business.  But as in my original response, a negative result with the outdated tests is reliable; the difference with HerpeSelect and Biokit is in interpreting positive results.

As to your symptoms, as suggested by Sarah_C, a reaction to N-9 (even though you have used it before withhout problems) sounds plausible.  However, I can't compete with the opinion/diagnosis of a doctor who has actually examined you, especially a dermatologist.  Your symptoms may be related to anxiety more than anything else.

Good luck--  HHH, MD

[dmann411]

Thank you for your responses. Following up... since my dermatologist seems a bit stumped other than to say general contact dermatitis, if this was in fact caused by N-9, would it have lasted this long (now in its 7th week, although gradually getting better)? Is there anything that can or should be done to speed healing in that case?