Yeast/HPV?? on nipple and penis

[citrus1987]

Hello Dr Thank you so much for your work.



A year ago I visited a Massage Parlor and received a "hand-job".  The worker however licked my scrotum and left nipple.



At the time I thought nothing of the possible risk.



6 weeks later,,, (Jan 1, 2006) My left nipple started tingling and burning (very much more than my imagination) During this same time I noticed two open lesions just under the head of my penis. (attached to each other and red soft scars remain today from this)I think these lessions started with two very small white bumps.  As two days progressed the lessions stayed the same, however the about 60% of my foreskin became red and inflamed.  It seemed to spread. I am circumcised.  There was also a day or two when it was uncomfortable to urinate.



I went to a walk in clinic and the provider thought it could be Herpes, with a remote possibility of Yeast.



She prescribed Valtrex and Nystatin Triamcinolone Acetonide Cream.  I used both and In about 2 weeks symptoms cleared for the most part.  Since the first outbreak, I have not had such severe symptoms.



I still however have an ongoing problem of sensitive foreskin.  (never had this in the past)  There is usually a section on my foreskin that is uncomfortable.  The skin looks a little more reddish there, however seems to have the same texture of the rest of the foreskin.  I went to another walk in clinic 3 days ago and the Dr. said it seems like yeast, and seemed to notice some fungus.  He prescribed Nystatin cream (without Triamcinolone Acetonide)  I did not realize at the time I had already tried Nystatin during first outbreak.



By the way, in the past  9 months there was about a two month time when the discomfort on my foreskin disappeared.  It does however exist today.



I am happy to Negative Blood Tests for Herpes (Herpeselect) HIV, Clamydia (chlamydia) etc...5 months after exposure.  11 months out I tested neg. to herpes again using herpeselect.



I obviously hope that this is just a yeast infection but really have some concerns.



#1. Could I have contracted something untested for from the sex worker licking my scrotum and nipple.  It seems just to coincidental to have genital symptoms and nipple symptoms at the same time.  



#2. Could I have received a yeast infection from the worker on my nipple and genitals from her oral contact.



#3. I don't think my symptoms seem like HPV and I know exposure from oral is low.  Could it be a "flat" version of the virus.  Can I rule out HPV?



#4. Could this be yeast that just wasn't cured by the initial use of cream.  I by the way do not have any other apparent "yeast" symptoms.  I currently am in good shape dont eat much sweets or bread, do enjoy beer though.



Something is just not right down below.  I have not dated in 9 months because of this.  I dont want to transmit my situation to another person.  

[H. Hunter Handsfield, M.D.]

Your symptoms don't suggest any STD, and you could not have acquired any STD from the massage parlor exposure you describe.  The only theoretical (tiny) risk might have been for herpes, and that has been ruled out by your doctor's exam and the blood test result. HPV doesn't cause the symptoms you describe.  The specific answers to your questions are:  1) Nothing I can think of.  2) No.  If you have a yeast infection, it is from your own body.  (We all carry yeasts normally on our skin and in various body cavities.) 3) Yes, you can rule out HPV.  4) I cannot diagnose what I cannot see.



Follow up with your provider if you remain concerned.  But put STD out of your mind.  You simply do not have anything related to the massage parlor exposure except perhaps an overly anxious guilt reaction to it.



HHH, MD