Ulcerated Hard Raised Papule on Red Base and Flu Like Symptoms?

I stupidly had multiple acts of unprotected vaginal intercourse with a woman.  36 hours following intercourse, I woke up with a very sore throat and 48 hours after the intercourse, I developed a 102 degree fever, felt sick, and noticed that the skin at the base of my penis on the top and to the side had become bright red.  The red skin was also sensitive to the touch and there was a very small red papule on top of one area of the reddened skin.  By Monday night (approximately 72 hours following intercourse) this papule had grown to be fairly large, felt hard to the touch and was raised above the base skin a fair amount.  It was also very painful to touch at its center.  

Shortly thereafter without forming any visible blister or vesicle, the painful center of the papule became ulcerated and a scab like plug formed in its center.  I accidentally knocked out the scab like plug and saw in the middle of the raised, hard red papule there was a moist indentation of raw looking skin.  This raised red papule lasted approximately 2 weeks and a scab formed in its center again as it healed.  It remained very painful in the center for most of the two weeks.

Apart from the papule described above I didn't have any other genital skin disturbances until 5 days following intercourse.  Then I developed two very small red raised papules in my pubic region on the same side as the initial papule and small red papule on the other side. Papules each went away within 3-4 days without blistering & they were never painful or sensitive.  But when they disappeared they left very faint pink skin underneath.  

Also, during whole period 2-4 days following intercourse I continued to feel very sick (sore throat and lethargy) and ran 102 fever.  Saw a primary care doctor 6 days post intercourse who was not very familiar with herpes. She guessed herpes but wasn't sure.   All STD tests (including  type specific IGG were negative).

Is there anything else that fits above symptoms?

[Edward W Hook, MD]

The fact that this has resolved makes it a bit harder to sort out.  I will make several comments which I hope will help but at this time, it sounds as though the process has, in large part, resolved and thus the most appropriate next steps may be to wait and see if the process recurs.  If it does, you should see your doctor ASAP and get any lesions present tested, including a culture or PCR tests for herpes.  Additional comments:

The lesions and their course sound very much like a bacterial skin infection (folliculitis) which is indeed very common and follow the course you describe.  Herpes is also in the mix and your negative blood test means only that you have not acquired herpes in the past.  It is of little relevance to recent events.  Finally, the only other STD which comes to mind is syphilis.  Little about what you describe sounds like syphilis and the disease is very, very rare (you probably had a syphilis blood test as well which, unlike the herpes blood test, is more likely to be accurate at the time you were tested)..

Non STD causes (besides folliculitis) include allergic reactions or drug eruptions to any number of chemicals, soaps, vaginal hygiene products, etc which you might have encounter in the course of events.

The sore throats fevers, etc are just as, or more, consistent with some other community acquired virus than an STD.

Hope this helps.  As I said, at this juncture, the best thing to do is to wait and see if it comes back, all the while hoping that it does not.  EWH

[BC1984]

I just want to make clear that when I wrote all STD tests were negative that did not include any cultures.  The doctor thought the lesion had healed too much to be successfully cultured, so no culture was done. Also, I was not on any medications or other drugs at the time of the outbreak described above.