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Ureaplasma, yeast, herpes or something else?

I'm a 22 year old male. 4 months ago I received oral sex from my long term(and only) partner of 2 years. 60 hours after oral sex she feels the beginnings of a cold sore.
Event 1(3 days)
After 18 days, there’s some foreskin irritation/itching though I had not showered for a few days. Urine appears to be the initial irritant. Whole glans and all underside of foreskin become bright red. Not painful but a little sensitive and itchy. 2nd day symptoms subside. 3rd day a sticky white goo is under the foreskin. No lesions, blisters, broken skin. I had similar symptoms in the past and dismissed it as balanitis.
The problem recurs in 6 weeks(same symptoms). Hygiene slightly poorer than usual. Urine again seemed to be the catalyst. No lesions/blisters. My GP says a previous positive result from last year for ureaplasma/mycoplasma could be the cause(retest positive for “mild infection”).
Event 2(7 days)
5 weeks later, slightly different symptoms. Hygiene was fine but urine irritates. Slight itch(no pain) in small area at rim of the foreskin next to the urethra. Symptoms come and go. Day 2 fine, day 3 stinging itch, day 4/5 fine, day 6 itchy again. Itchiness only occurred when urine was in the area. Symptoms promptly went away after drying/showering. No lesions, blisters, sores, open skin. I saw GP(day 5) who quickly inspected the area saying it was ureaplasma again but definitely not herpes.
Things fine for 8 days until the same symptoms appear in different area 1.5 inches away, still on rim of foreskin (outer side). I see small flat red spots in area. Itches when in contact with urine. Spots/itch fade in 3 days. No blisters or sores I can see but a noticeable increase in smegma(glans).
My partner has recently had white discharge(semen-like) and an unbearable itch at times on both sides of the vulva where the labia minora and majora meet.

Is this clearly something other than herpes as my GP suggests?
Does this sound like a “mild” ureaplasma infection? Yeast perhaps?

Thanks!
7 Responses
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Avatar universal
A related discussion, Urea plasm was started.
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Avatar universal
Thank you Dr HHH. I was most concerned about herpes but am reassured you agree with my GP in thinking that was not the cause. Re-reading my response, I should clarify that my GP has not thought HSV testing necessary in the past. I assume her clear position on HSV during event 2 would mean she would not test even if prompted but this was before the subsequent (similar) symptoms and unraised red spots.

The sticky white "smegma" (which also formed a sticky film on the glans and foreskin, causing difficulty retracting the foreskin and "peeling" off part of the film in the process) has not returned and the foreskin retracts easily with no symptoms. I will continue applying the yeast treatment daily until 2 weeks has elapsed (perhaps changing to a non-steroid anti-yeast cream) and inform my current partner she may have a yeast infection to prevent reinfection between us.

I will inform my GP next time of the likely possibility of yeast (since she had prescribed me 3 weeks of antibiotics to clear up the ureaplasma) and consult my local SHC next time I have any STD concerns.
Helpful - 0
239123 tn?1267647614
MEDICAL PROFESSIONAL
Since your symptoms are clearing up, I doubt you'll ever know the cause for sure -- although a yeast infection seems most likely.  It should be safe to have sex with new or any regular partner you may have and I see no need to inform partners of this issue.  However, no distant expert can guarantee anything along these lines.  If you remain uncertain, consider talking again with your GP or perhaps visit your local SHC.
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Avatar universal
Understood. Final question: Is it safe to move on and see a specialist if/when there is a recurrence or should I see one soon to explain the symptoms and get their opinion (and do I need to refrain from intercourse/inform new partners in the meantime)?
Helpful - 0
239123 tn?1267647614
MEDICAL PROFESSIONAL
Lab tests for ureaplasma are not helpful, whether positive or negative.  The organism is found with equal frequency in sexually active people with or without symptoms of any kind.  Your apparent positive result says nothing about the cause of your symptoms, which in any case aren't typical for ureaplasma anyway.

I agree with your GP that no testing for HSV is warranted on the basis of your exposure or symptoms.

Apparently you are uncircumcised, in which case fungal infections (yeasts or other fungi) are more common than in men without foreskins.  If that's the cause, an antifungal cream (e.g. clotrimazole or others) usually is adequate treatment.

Australia's national health service (or whatever it's called) sexual health centres are, collectively, the world's best network of STD/HIV clinics.  If you're in or near an urban area, there's probably an SHC available.  I recommend the SHCs as a superior resource for any and all concerns about STDs or other genital area medical complaints.
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Avatar universal
Thank you Dr. HHH for your response and all your work on this forum; I’ve read many of your posts and they’re always very helpful.

- I should have mentioned I also have regular, unprotected vaginal sex with my partner for the past 2 years hence my concern about yeast. Not sure of her HSV-2 status but I was concerned about oral sex as she gets cold sores and the possibility of prodromal shedding.

- I recently tested "mildly" positive for ureaplasma, negative for chlamydia and gonorrhoea.

- I have asked my GP about blood/swab tests for herpes but she did not think it necessary. I’m from Australia and herpes tests are uncommon and doctors seem quite reluctant. I will certainly be following your advice and seeing a specialist from now on though.

- I reasonably suspect (but not sure) that I have oral HSV-1. My mother occasionally gets cold sores and I remember 2 weeks of particularly painful, weeping bumps at the corner of my mouth during my youth that formed a distinctive yellow crust/scab. No recurrences though. I have also accidentally kissed my partner during (not prodrome) an outbreak several times without subsequent oral symptoms. In light of this, should I still get a blood test or is a swab test better if/when symptoms return?

- It’s currently day 6 of the last event (with the red spots) and other than barely visible red spots (no sensation after day 3, even touching them) no symptoms. I thought it strange that herpes would totally disappear for a week and then reappear in a different spot so I applied an anti-fungal/yeast with Hydrocortisone 1% on day 4 just in case it was yeast. The residual dryness and very minor generalised itching of the foreskin “rim” went away overnight. More noticeably, the white “smegma” that would form all over the foreskin and glans in a few hours every day/night during event 2 (even while sleeping with glans exposed) disappeared. I applied it once a night. Over 48 hours now and there has been no white “smegma” at all (which is more normal for me). Not sure if this is significant for yeast?

Thanks!
Helpful - 0
239123 tn?1267647614
MEDICAL PROFESSIONAL
Welcome to the forum. Thanks for your question.

I don't think any STD explains your symptoms.  The exposure was low risk; although oral exposure isn't entirely risk free, STDs are much less common than from vaginal or anal sex.  And the only STDs for which you were at risk at all were gonorrhea and NGU, either of which fits your symptoms, and herpes -- which also doesn't fit fro a variety of reasons.  Ureaplasma can't be acquired by oral sex; it isn't carried in the mouth.  And anyway, it isn't clear that ureaplasma ever causes any important infection at all -- some strains may, but others clearly do not.  Other mycoplasmas also aren't likely -- and on top of all this, even a test for these bacteria doesn't help, since they are normally present in the urinary tracts of entirely healthy men and women.  Finally, genital yeast infections are not common in men, although yeast conceivably could explain your partner's discharge and irritation.

Have you spoken with your GP about testing for herpes, either by direct viral test (culture, PCR) or a blood test?  I don't htink you have herpes, but these tests could confirm that.

At this point, I would advise you to see a specialist.  If you're in the UK, your local NHS GUM clinic would be an excellent choice, or a private sexual health clinic like London's Freedom Health Clinic.  In the US, a local health department STD clinic would be test.  Or see an infectious diseases or other STD specialist.

In the meantime, you shouldn't be highly worried.  Your symptoms are not very suggestive of herpes or any other STD.  

Good luck--  HHH, MD
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