STDs Expert Forum
is this herpes? std risks?
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The STD Forum is intended only for questions and support pertaining to sexually transmitted diseases other than HIV/AIDS, including chlamydia, gonorrhea, syphilis, human papillomavirus, genital warts, trichomonas, other vaginal infections, nongonoccal urethritis (NGU), cervicitis, molluscum contagiosum, chancroid, and pelvic inflammatory disease (PID). All questions will be answered by H. Hunter Handsfield, M.D. or Edward W Hook, MD.

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is this herpes? std risks?

Hello Dr,
I'm a 27 year old male living in Syd Australia. Around one and a half weeks ago I had insertive unprotected vaginal and received/gave unprotected oral from a Thai girl staying here in Sydney. I do not know her sexual past, only that she is here on a student visa and appeared extremely promiscuous - initiated/wanted unprotected sex. Since the encounter I've had a slightly irritated meatus/urethra and had figured it was a UTI. Slight irritation urinating and slightly weaker stream/urinating more but smaller amounts. I was hoping it would clear up on its own since the irritation seemed to come and go. It hasn't cleared and approx. 1 week after the encounter I also noticed red bumps on the head of my penis (uncircumcized) and also on the shaft underneath the foreskin. There are 4-5 red flat looking bumps/dots (small) less than 1mm in diamater on the head. Seems like another 1-2 on the opposite side too. They are close together but don't appear to form a cluster and skin underneath appears normal. Also, underneath my foreskin where the head joins the shaft there are 1 or 2 red pimples (less flat) which seem to form whitehead over night (for the last few days), white head comes off with shower. I've been applying canasten which hasn't seemed to significantly improve or make the situation worse. The bumps themselves are not itchy or painful to touch. They are too small for me to tell if they are fluid filled. Prior to this encounter I was cleared with bloodtests for all STD possible (including hsv1 and 2) so I know that if I've caught something it was the above encounter I describe.. Two main questions - Please let me know what you think the rough STD risks (including HIV) would be for unprotected vaginal/oral with a promiscuous Thai girl staying in Sydney Australia. Also, my main question is - do the symptoms above sound like Herpes? If not, would it be yeast (i drink a lot of beer), fungal, irritation? Thank you.
239123_tn?1267651214
Welcome to the forum.  You have asked some questions on the HIV forum in past years, but I think this is your first time on the STD forum.

Herpes doesn't typically behave in the way you describe.  Initial herpes typically is excrutiatingly painful when it occur in moist, closed areas -- like on  the head of the penis or the inside of the foreskin on uncircumcised men.  (That's why herpes is typically more debilitating in women than men.)  I would be much more suspicious that you have yeast balanitis, or "nonspecific" balanitis.  (Balanitis is the medical term for inflammation of the head of the penis.)  While canestin typically would suppress yeast (fungal) infections, it is not active against all of them.  If it's yeast, by the way, it has nothing to do with beer intake!

So my guess is that this has nothing at all to do with the sexual exposure you are concerned about.  I also doubt you have a nonsexually acquired UTI, which is very rare in younger men.

Australia's sexual health centres are, collectively, the very best network of STD/HIV clinics in the world, in my opinion. And Sydney's is the best of the best (or at least tied with Melbourne, which also is a superior clinic).  I would advise you to take advantage of the world class expertise available to you and visit the Sydney SHC.  I will be interested in a follow-up comment to learn what they have to say.

Best regards--  HHH, MD
7 Comments
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Avatar_m_tn
Hello again Dr Handsfield. My anxiety got the better of me and I ducked out on my lunch break (despite being very busy) to the local medical center. The Dr examined my penis and has taken a swap (of one whitehead under foreskin/not on the head that looked 'open'). He also had me provide urine samples. He's prescribed Cephalexin hoping it will clear up the irritated urethra symptoms I've been having. I asked him to rate out of 10 his personal view that it is herpes based on other examinations he's conducted (i have anxiety issues). He said 2/10, that it really doesn't resemble typical herpes and also said like you, that a primary outbreak would be very painful down there. He took the swab (better safe than sorry). He pressed down quite hard on the 'open' pimple/bump and asked if it hurt - it didn't. He said I should continue using canestan for the spots/pimples and to keep an eye out for blistering/scabbing/pain etc. He didn't actually provide a reason for my existing symptoms but I'm to return there in two days for urine and swab test results. I am slightly relieved but still worried. Does this extra info allow you any additional feedback/comments? Should I be concerned about herpes or other STD's? Thanks so much for your help. Really appreciated.
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239123_tn?1267651214
This information doesn't really change my opinion or advice.  If anything, it makes me think even more that you don't have herpes.  I'll add that I'm skeptical about the value of cephalexin; if you have a yeast infection, it could make things worse.  I'm sorry you didn't heed my advice about the SHC.  In any case, I definitely expect the swab test for HSV to be negative.
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Avatar_m_tn
Hi Dr. I'd have preferred visiting a SHC clinic but I work in the suburbs and with sydney traffic it's not really possible for me atm to travel inner city. Is there a particular topical cream/pill antibiotic or course of action you'd recommend?? Your reassurance is calming. All I've read/advice I've been given suggests this is not HSV. My worry wart side isn't entirely convinced unfortunately ;) Will see how I go in a couple of days with test results. I'll only post again on this thread re results or to answer questions. Thanks again and Regards, Jay
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239123_tn?1267651214
Aside from being confident you don't have herpes, I don't know what you have and would not venture any further guesses about treatment.  Since you have seen a doctor in person, that is the person to ask about other tests, treatment, etc.  
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Avatar_m_tn
Hi Doc, I went to get my urine and swab results today. All clear for HSV 1&2 with swab and urine didn't show any STD either. Still slight irritation of meatus/urethra and now the whitehead like pimples on underside of my foreskin have cleared. Those on the head have lost their white heads and seem to be fading also - resemble small red pimples (3 of them). Dr suggested I continue with keflex but stop using topical creams on the bumps. How confident can I be that I haven't contracted HSV1 or 2 from this encounter? Do you think my exposure (first post) warrants full blood screening in a months time for HIV, syphilis etc? Your responses really helped me deal with my anxiety leading up to today, so thank you again.
Regards,
Jay
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239123_tn?1267651214
As I said, you should follow up with your own doctor about persistent symptoms, response to treatment, etc.

Since your doctor is confident you didn't catch herpes, so am I.  In my opinion, this sexual event does not in itself require STD or HIV testing.  In general, I always recommend against automatic testing after individual exposures, unless there are typical STD symptoms (which you have not had) or the exposure is particular high risk (which yours was not).  A smarter approach for people who are sexually active outside mutually monogamous relationships is to have routine testing from time to time, like once a year, but to ignore individual exposure events.

That will end this thread.  Take care.
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