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What is causing this strange recurring sensation on penis after unprotected oral?

About 9 months ago I exchanged brief anonymous oral sex with another guy.  The first sign of a problem was 4 days later when I had burning when urinating but this happened only once.  I've had very infrequent irritation after urinating off and on but the main issue has been random burning/tingling on my scrotum and penis.  I've also had sore lips and gums occasionally. Over the months I have seen a couple of family doctors, a urology nurse practitioner and a dermatology nurse practitioner.  All STD testing came back negative. I have been given a variety of diagnoses including UTI, fungal infection and lichen planus.  I'm not convinced any of them are correct.  I've been on different antibiotics, antifungal creams, etc.  

My symptoms have slowly improved over the months yet I still have this recurring sensation.  The strange thing is it is in the same two spots the great majority of the time.  I feel it on my lower right lip and on my penis in a spot where the corona meets the shaft- I'd say about a 1/4" diameter.  There has never been any sore present and usually the area looks normal.  Sometimes I notice only a little redness in the area on my penis.  The feeling is hard to describe but feels similar both on my lip and my penis.  I would describe it as tingly, irritated, raw- like I said it's hard to describe.  I notice on my penis it usually feels better if I retract the foreskin. The discomfort comes and goes- I'll feel normal for 2-3 days only to have it return for several days.  

What would cause this recurring feeling just in these two spots?  Is it related to that sexual encounter or is that just coincidence?  Could it be nerve-related?  
1 Responses
207091 tn?1337709493
What kind of testing have you had done? I would assume you've tested for gonorrhea, chlamydia, NGU? What about herpes? Have they done a prostate exam? Have they sent your urine out for a culture? Have they actually looked at the area you are talking about?

Did they do any oral STD testing, like oral gonorrhea testing? You exchanged oral sex - did you also kiss?

Have you taken any meds? What meds have you taken?

When you have the tingling on your lip, do you have it on your penis at the same time?

Honestly, without knowing what testing you've had, exactly, it's hard to say what it is. It could be nerve-related, it could be just irritation at this point.

What has your doctor said about these two spots? When you've had the recurring burning/tingling/etc., have you had them in these spots?
In July 2019 I was tested for chlamydia, gonorrhea, trichomonas, HIV, hepatitis and syphillis.  All were negative.  At the end of August about 6 weeks after exposure I tested negative for herpes- HSV 1 and HSV 2.  I have not had a specific test done for NGU.  I have had a prostate exam which found it to be a bit enlarged (I am 58 yo).  Flomax has helped with urine flow but I think that was a separate issue.  I have had three urine screens done (one at PCP office and the last two at urology).  Only the first one showed slightly elevated leukocytes- the other two were normal.  I don't think it was sent out for a culture- just what they do in the office.  Several doctors have looked at the area but like I said there really isn't much to see besides an occasional small red spot on my penis but even that's not there every time.  

No oral STD testing was done.  Should it be?  There was no kissing.

I have been on many medications.  In order- Macrobid for supposed UTI, azithromycin and doxycline, fluconazole (for possible thrush), ketaconazole cream, nystatin, desonide ointment and clobetasol.  I have also tried OTC neosporine and Man1 oil.   I have stopped all of these but continue using the Flomax.

I do get the tingling on my lip and on my penis at the same time.  These two spots are where the recurring burning/tingling is the great majority of the time for about the last 2-3 months.  Prior to that I'd get those sensations in different locations.  It sometimes feels like a "cool burning"- like when you put Icy Hot on your skin. Sometimes I will have a burning irritation in my urethra after I urinate.  It goes away after a period of time.  I'm having that right now again.  My PCP seems to blow me off.  The NP at the urology office wasn't sure either and just told me to come back if it doesn't go away in a few months.  I saw both of them when I was having the discomfort in other spots (e.g., the frenulum area was feeling irritated off and on for awhile).  The NP at the dermatologist's office said lichen planus but the ointments he gave didn't help.  He said next step is a biopsy but area would have to be red and irritated (and it usually isn't).  That appointment is tentatively scheduled for the middle of June.  

I think I answered all of your questions.  What do you make of having the discomfort at the same time in both places?  What about the occasional irritation after urination?  Should I get oral STD testing?  Or for NGU?  I've never had a discharge and if I do have "burning" it's after urinating and not during.  Any other kind of testing I should have?  This has been going on for almost nine months and it's getting old. Thanks in advance!

If they even did a urine test in the office, they can tell if you have NGU - they will be able to tell if you have an infection, and only one of your tests showed slightly elevated leukocytes - that's good.

I asked about herpes testing because I was wondering if the person who gave you oral had hsv1, but you tested negative for that.

Prostatitis can give you a lot of your symptoms. So can dehydration. Are you drinking enough water? Too much caffeine or alcohol?

I don't know about the tingly spots on your lip and penis. Maybe it's anxiety. Don't discount that - anxiety does a number on our brains and can present with very real physical symptoms.

Also, don't discount the symptoms of BPH. With other types of prostatitis, eliminating caffeine really helps. I don't know if it does with BPH, but caffeine can be really dehydrating. If that's an issue, work on that.
Oh and if you had an oral STD, it would be in your throat, not on your lips unless it was oral hsv1, which you've tested negative for. I don't see any reason for you to take an oral STD test, unless you want it for peace of mind. The only thing you'd need is a throat swab for gonorrhea and chlamydia.
Thanks for your quick response.  Would there be any point to having another herpes test?  I've never had any actual sores.  Was 6 weeks long enough to wait?

I am probably not drinking enough water.  Caffeine I don't think is too bad- maybe 1-2 cups of coffee and a soda daily.  Alcohol is around 8-12 beers per week.  I could try cutting that back as well.  

Did you ask if I get the tingling on my lip and penis at the same time for a reason?  I always thought that was odd.  I have considered anxiety.  I have not seen a connection between feeling increased anxiety/stress and onset of the symptoms but perhaps that alone doesn't rule it out.  I have used clonazepam prn for many years so am prone to anxiety.  I just don't want to attribute it to that if something else is going on.

Would you agree that it is likely not a yeast or fungal infection given the meds I have tried?  Any reason to think whatever this is could be transmissible to my wife?  I don't want to be passing anything on.  Thanks!
Yes, I asked about the tingling because I thought maybe herpes. By 6 weeks, 70% of people will test positive. It wouldn't account for most of your symptoms, though. You can do another test, but I don't think it will change much.

In our Men's Health forum, quite a few men have said that eliminating caffeine and alcohol has helped their chronic prostatitis the most - which is different from BPH, I know, but it can't hurt to try. At least try with the soda first - that also has carbonation, which is an added irritant. Alcohol and caffeine are both really dehydrating. Add not drinking enough water, and that could account for some of your symptoms. Starting there may be the easiest.

I don't think it's fungal or anything transmissible. You've tested for everything, and tried all the antifungals.

Maybe the lip is just a twinge that you are hyper-aware of because of anxiety, and maybe guilt. Have you thought about counseling? I don't know if you are quarantined full time, but most therapists are offering online therapy now. I'm sure your wife is aware of your anxiety, so you don't need to go into all the reasons why you want therapy.

But start with decreasing caffeine and alcohol, and increasing your water. Those are easy things to do. :)
Thanks for your input.  I have been drinking more water, cut back on the caffeine and have had no alcohol.  Not noticing anything yet but it's only been a couple days.  I'll look at the Men's Health forum for more information.  The main problem is the two hard-to-describe spots on my lip and penis.  It feels like it is on the skin surface but like I said usually don't see anything except an occasional little red spot on my penis.  

I wouldn't describe it as a "twinge"on my lip.  More like a chapped spot- not dry but a bit raw, irritated and maybe stinging.  Same for the spot on my penis.  It's there for a few days then okay a couple days.  Has come and gone like this now for many months.  I was reading about herpes but it seems like with that it isn't as ongoing.  Someone has an outbreak, they deal with that for a few days and then it goes away for awhile.  Is that correct?  I had a "herpes simplex PCR" test that was negative.  Is that the right test?  

I know a bit about anxiety and therapy having been a therapist for the past 30+ years :)  I have had physical symptoms in the past that I know were anxiety-related (e.g., palpitations, chest pain, lightheadedness) but not sure about these symptoms.  I guess it's possible.  I know I am more aware of these sensations and that it often is better when I'm busy and distracted with something else.  But that's true for many physical issues.  I'm certainly not proud of what I did so guilt could be a factor.  Like I said before I just don't want to attribute it to anxiety if there is a medical condition that could be treated.  

So with that in mind any other things you think I should rule out?  Any other tests to have or specialists to check with?  Any value in another herpes test other than peace of mind?  I will continue with the dietary changes and see how that helps.  Thanks again auntiejessi!

Was the herpes PCR test a swab? If it was, that's a great test, and it's very sensitive.

I understand wanting to rule out physical causes, and I think that's a must, always. I don't see much of a need to do other herpes test other than peace of mind, but with your anxiety, it might be what you need. Get a type-specific IgG herpes blood test. Don't do the IgM - it's a worthless test.

For the spot that feels raw - pay attention to what you eat, touch, etc. Maybe it's as simple as an allergic reaction or sensitivity. Is that a spot on your lip that you often touch? Is the spot on your penis a place you often touch? Maybe you're having a sensitivity to hand lotion, soap, etc., or something you'd never think of.

The herpes PCR test was a blood test not a swab.  Still do the IgG test or not worth it?  I don't touch the spot on my lip with my fingers but maybe more with my tongue when it's bothering me.  I don't touch the spot on my penis.  No changes in hand lotion, soap, laundry detergent, etc but I will try to pay more attention to it.  
The PCR blood test is really unreliable. Herpes is not in the blood, the antibody is in the blood. Definitely do the IgG test. Here's an explanation from Terri Warren on it if you need confirmation of what I say - https://westoverheights.com/forum/question/confirmed-dx/

Basically, you have no more information than you did before you took the test, unfortunately.

Hi auntiejessi,

I had the IgG test done and here are the results.  HSV 1 was high at 36.80.  HSV 2 was normal with a result of  >0.91.  I know my wife has gotten cold sores on and off since her teens but I never have.  I'm guessing I picked that up from her and have probably had it for years and not known about it.  It brings up some questions-

Not sure this explain the symptoms I'm having now with this sore spot on my lip and penis.  What do you think?

Can someone get the irritated feeling in a spot but never have a sore develop?  

Can someone have HSV 1 for years with no symptoms and then have it begin to cause symptoms?

Is there any recommended treatment for HSV 1 if this is my issue?

Lastly I continue to drink more water, have not had any soda and only 2 beers.  Yesterday was the first day in over a week where the symptoms felt better.  But today I'm feeling it in both spots again.  It's hard to know what's helping and what's not given how the symptoms come and go. I will continue with these dietary changes (because it's good for me anyway) but would there be any other conditions I should rule out?  Chronic nonbacterial prostatitis?  Male genital dysaesthesia?  (Can you tell I've been reading stuff online!).

Thanks for any input!
You could have gotten hsv1 from her, or when you were a kid from a well-intentioned family member who kissed you, or someone you kissed before your wife. You'll never know, and it doesn't matter. 90% of those with oral hsv1 never get any symptoms, so it's often really hard to know when you got it.

It's really hard to say if that explains the symptoms you're having. If you have a newer infection, it could. It would be really unusual that you just get tingling with no outbreaks, though.

I don't know if you can get chronic nonbacterial prostatitis on top of BPH - that's a question for your urologist. Wait - I think I'm assuming you have BPH based on your meds and "enlarged prostated" and age - do you have that? I'm not sure you've said that.

This is all because of oral sex with a man, right? Honestly, how much of this could be guilt and anxiety? I know we've talked about this before, but your tests, other than hsv1, which you could have had for years, are fine. I'm not discounting your symptoms  - not at all. But there is nothing that would cause tingling on your lip - even with herpes, you'd have to have an outbreak before you'd have tingling.

The genital symptoms could mostly be attributed to the prostate - whether it's BPH, CPPS, chronic prostatitis, etc. Are you scheduled to follow up with your urologist?

I'm glad the dietary changes have helped, at least somewhat.
So it sounds unlikely that the HSV1 explains my current symptoms.  I'm not even sure I would describe the feeling as tingling.  Like I've said before it's hard to describe- raw, tender, irritated.  Usually it is just in those two spots when it happens now although months ago my gums and lips were sore as well.  That came back a bit last night but not today- back to just the one spot.  

I guess I do have the BPH which the Flomax helps with.  I do not have a urology follow-up appt scheduled.  I think the NP I saw was stumped and she just said call back if I wanted.  I always thought the symptoms on my lip and the ones on my penis were related to the same condition.  But you're thinking it could be separate?

It's certainly possible it could be guilt and anxiety.  Just seems like weird anxiety symptoms- not the usual palpitations, GI upset, lightheadedness, etc.  I'm assuming it is not an STD given the negative test results.  Safe to say?  And again nothing that would be transmissible to my wife?  Can you think of any other medical conditions not STD-related that could explain my symptoms?  Seems like I'm running out of medical explanations and what's left is the psychological.  I guess that's not a bad thing.  Always easier to just take a pill though than deal with all that guilt stuff! :)

I mean, it could be an allergy to something you are eating, lip balm, gum disease, or any combination thereof, for the lip/mouth stuff. Maybe you're biting it in your sleep? That could be anxiety, maybe.

Yeah, I think they could be separate, but I'm not a doctor, nor am I your doctor.

You have tested for all STDs - all were negative. The only thing positive was hsv1, which your wife already has. You can't give her what she already has. Consider that a wash.

Anxiety comes in a lot of forms. Not everyone experiences the GI upset, palpitations, lightheadedness, sweating, etc. Some get compulsions - reading stuff endlessly on the internet, buying masks for covid, calling people to reassure themselves that everyone is safe at home. Some get really hyper-aware of their bodies, and notice every twinge and tick. Others stay inside. Others can't watch certain things on TV in avoidance.

I can't tell you if you fit any of those, or the many other forms it takes. But you're a therapist. You know this. (And things are totally different when you experience something you've been clinically studying for years, I know.)

Pills are always easier lol. I wish it were that easy for you. :)

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