Unusual Symptoms??? HELP!

[tresterat]

Dear Doc.

I am a 23 year-old uncircumcised male. I made the mistake of having unprotected sex with an older woman (aged 34) about four days ago. We have had rough sex, multiple times.

I usually keep the head of my penis covered by foreskin; I only pull it back when I have sex. This time, i left it retracted until about the day after, while I was showering, I decided to pull the foreskin back over. It was very painful and difficult to do.

The next night, I start feeling a burning/tingeing sensation down there. The next morning, I developed a small, elongated lesion on the tip of my foreskin. It was neither bumpy, nor clustered like the pictures of herpes I've seen. Instead, when I pulled the foreskin back, it is rather shallow, redish/white, and one elongated blister like lesion. It does not hurt when touched, just a little sensitive and sore. I immediatley went to the local STD clinic to get it checked out. Doc said at first it looked like herpes, but when she went to take a culture, I told her it didn't hurt, and it didn't seem to puss, or burst as she went to apply pressure to it. She took a syphilis culture, and initial lab work came back negative. She checked my fever and lymph nodes and everything seemed fine. The only symptoms I have are burning/tingling, no trouble urinating when foreskin is retracted, a slight discomfort of testicular area and upper thy, and occasional abodimale pressure (don't know whether its from stress of dealing with this and lack of eating regularly or what)

Today, I noticed a large build up of smegma under the foreskin, and red, painless dots on the head of the penis. Also, there has been a distinct and pungent odor emanating from down there. Could this be penile candidis? or some form of a yeast infection? Could the blister be the result of friction as I tried to pull the foreskin over the head of my penis. Does this sound like the typical case of Herpes?

[Edward W Hook, MD]

This does not sound like herpes or, for that matter, any other STD.  Rather it sounds to me that the friction and trauma of what you describe as rough sex created some irritation.  This in turn was probably made a bit worse by some local swelling and perhaps a slight decrease in blood flow as the result of leaving your foreskin retracted for a prolonged time.  Finally, the smegma buildup is likewise a non-specific reaction to the local irritation.  There are really no STDs that appear only a day after exposure.  My advice is not to worry about STD.  You have been evaluated and tests are pending.  If it is not substantially better in another day or two, return to the STD clinic. The clinician sounds like they are doing and thinking the right things.  Hope this helps.  EWH

[tresterat]

Thanks Doc, that is a little reassuring.

A couple of clarifications: The burning/tingling sensation occurred about 48 hours after intercourse. The next morning, the blister/lesion appeared. After about 4 days, the red, painless dots on the head of the penis appeared, along with the build up of white crust around the head.

I'm more concerned with the blister. They say herpes blisters are intensely painful, and rupture rapidly and leave ulcer like openings. Should it have ruptured by now?

When evaluated level to the foreskin, it is not even raised ABOVE the skin, it seems like its almost apart of the skin. And once again, it is not clustered or a series of blisters, it is almost like a burn mark you get when you touch your arm to hot pan: an elongated blister like lesion that is white but red underneath.

[Edward W Hook, MD]

While herpes can present in an enormous specturm of ways, this really does not sound like herpes.  In addition, even at 48 hours you are still early for most HSV.  The only way to be sure however it to have a culture or PCR test which can be obtainedfrom your health care provider or an STD clinic.  EWH

[tresterat]

Doc,

The blister is still there, about 5 days since it first appeared. I started putting some bacitracin on it, and it felt slightly better the day after, almost no pain and redness seemed to subside, although I do feel some discomfort (wouldn't go so far to say as pain) in my left groin area...I'm really concerned that this is herpes. Would bacitracin releave the burning, pain if it was herpes.

And also, the blister is on the inside of my foreskin. What kinds of symptoms would I see if herpes appeared on the inside of my foreskin?

[Edward W Hook, MD]

Please re-read my earlier responses.  Bacitracin would not be expected to relieve discomfort due to HSV.  This does not sound like herpes.  If you are concerned, see a health care provider who can test for herpes (did you get tested as I suggested before??)  as well as hopefully tell you what it really is.  EWH

[tresterat]

Thanks Doc,

I was tested prior to posting the initial post. I am awaiting results, which should be back on Tuesday.

[tresterat]

Hi Doc,

My apologies in advance for continuing this thread, as I imagine you have more important concerns, but I have not received my results yet, and am going a bit crazy over it, as you could understand. I just have a TWO more questions.

The sore/lesion that appeared last Tuesday is almost completely healed, and there is nearly no discomfort. I was given Aclovyir by the doc at the clinic, but I did not take it because I wanted to see if the sore would heal on its own. It's been exactly a week to the day since i noticed it under my foreskin. Would a herpes blister heal so quickly, on its own, in such a moist area (it appeared along a crease on the tip of my foreskin) in so short a time?

Also, my symptoms (primarily a slight discomfort/pain of the sore, abdominal discomfort and occassional pains in my left thigh--these are the only symptoms, by the way, no fever, muscle aches etc.) have come and gone. Last Friday, there were no symptoms AT all, they returned on Saturday (perhaps excaerbated by anxiety), subsided to the point that it hand't felt like anything was there at all, returned on Monday, and were basically non existant today. Do herpes symptoms come and go so rapidly?

Thanks so much for any additional and MUCH NEEDED advice you can provide!

[Edward W Hook, MD]

First episodes of herpes typically take two weeks or more to heal,  for your lesion to heal in a week would be unusual.  the other symptoms you describe are not consistent with herpes.  EWH