Burning on head of penis

[paul1357913579]

I received condom protected oral and vaginal sex from an escort on 8/27, with handjob with saliva prior to condom.  It has been six weeks now and here's a summary of my symptoms and testing:

- Burning and irritation on the head and tip of my penis, along with muscle aches and sore throat, started a few days after exposure
- No white/yellow discharge, but clear discharge (sticky) once or twice a day between weeks 2-4
- 2 and a half weeks after exposure got tested for HIV, gonnorhea, and chlyamidia (both urine test), syphillis (blood), trich(urine), urine culture - all negative
- 6 weeks after exposure got a retest of gonnorhea and chlyamidia (results pending) and HIV (result was negative)

My current symptom 6 weeks out is this constant burning sensation on the head of my penis.  No increased burning during urination, since burning is already there.  It is sensitive to touch around the head of the penis as well as around the tip.  Overall the head looks more red in color, although there are times it appears normal.  There appears to be a small raised red bump next to urethral opening.  10 years ago I was tested positive for HSV2 antibodies by a blood test.  I never had outbreaks on my penis, except for itchiness on my buttocks and anus area.  So here are my questions:

1) What is your assessment of my current condition, relating to the burning of the head of the penis and redness near the urethral opening?  Do you think it is STI related?
2) Are my tests definitive, given that some of them were tested 2.5 weeks out and some at 6 weeks?  Are there any other tests you recommend?
3) Do you think my burning/redness symptoms could be indicative of STI that is either NGU or viral, like HSV2 or HPV?
4) Does my previous positive HSV2 result suggest my current symptom could be related to an outbreak in a new location?
5) Do you have any alternative disgnosis such as chronic prostatitis, kidney stone, or high BP (142/93 yesterday)?

[Edward W Hook, MD]

You should go and get examined.  EWH

[paul1357913579]

I understand, but one last question.  My sore next to my urethral opening is getting larger, raised, red, and looks like multiple pimples clustered as one. Along with the burning sensation at the tip, do you still rule out any STI, bacterial or viral and lean towards fungal infection?

[Edward W Hook, MD]

I think you are getting overly anxious about this and need to slow down and relax.  The additonal information, while confusing what might be going on and the assessment for the dermatologist,. does not change my opinion that this is not an STI and is not related to the encounter that you describe.  Your continuuing "what if" questions are not going to change my assessment.  To that end:

1.  STIs do not cause smelly urine.  Urethritis is typically due to STI.
2.  As I have already ssaid, what you describe does not suggest HSV for ANY reason.
3.  Spitting on the penis during masturbation.does not cause infection.

I think it is time for this thread to end.  EWH

[paul1357913579]

Thank you. I will go see my primary and get a referral for dermatologist. However, I ask you if I need a referral for a urologist instead or in addition since my urethra seems to be part of my burning. I just can't point out whether the burning is urethral or glans origin since it is all together.

I have also started lotrimin cream in my glans  prior to your recommedation not to start anything. Is this ok?

Also, I took 7 days QD 500 mg Levaquin during weeks 3 and 4 post exposure due to potential thought of prostatitis.

Do these add any additional thoughts to your diagnosis?

Also, my urine smells musky and burns a little. Are you ruling out any urethritis?

If I have already tested  positive for hsv2 and my outbreak was on my buttocks, is it possible to get reinfected at another site, such as tip of penis?

Finally, what STI is transmissible by someone spitting on your penis while giving you a handhob?

[Edward W Hook, MD]

Thanks for the additonal information. This makes me still more convinced that what is going on here is not an STI.  You have other skin conditions and sensitive skin.  I would ask your dermatologist about this but would not suggest antibiotics of creams at this time. In fact, if anything, I suspect they would just confuse things or perhaps make things worse.  Please do not worrry about STI. EWH

[paul1357913579]

Thank you for your responses.  To follow up on your questions, the health care professional did not see the redness near the urethral opening nor mention any abnormalities on the head of my penis in response to my burning complaint.  The slightly red raised bump (looks like a pimple) was only visible to me yesterday and after my visit to the clinic.

My symptoms started a few days after the exposure but really has been quite constant throughout the 6 weeks.

My only other skin condition is eczema, extreme itchiness on buttocks/thighs at start of winter, and sensitivity to spermicide.  My exposure involved use of Trojan ultrasensitive condoms which I don't know if it had spermicide.

Any other thoughts on my condition and/or diagnosis?  Do you recommend taking any antibiotics or antifungal cream?  If so, which ones?

Finally is it ok to have unprotected sex with my wife?

Thanks Doc.

[Edward W Hook, MD]

Welcome to the Forum.  I'll try to help.  I note that you have apparently been examined by several health care providers who performed test (a good idea) but it is not clear to me if they saw the same abnormalities on your penis that you describe. Did they?  The main process that comes to mind in terms of redness and sensitivity is a fungal infection (which would not necessarily be an STI).

Also, could you tell me if your symptoms are getting better or worse?

With regard to your specific questions:
1) What is your assessment of my current condition, relating to the burning of the head of the penis and redness near the urethral opening?  Do you think it is STI related?

From what you describe, I doubt it.  A fungal skin infection is a possibility, or perhaps some other dermatological process.  You don't happen to have other skin conditions, do you?

2) Are my tests definitive, given that some of them were tested 2.5 weeks out and some at 6 weeks?  Are there any other tests you recommend?

No, your tests were taken at a time when most of them would be quite reliable and that, combined with the lack of progression to an obviously recognized makes other STIs most unlikely.

3) Do you think my burning/redness symptoms could be indicative of STI that is either NGU or viral, like HSV2 or HPV?

See above- no.  The time course does not fit HSV at all, warts/HPV do not cause symptoms, and NGU should have been detected through the examination/testing you have already had.  Further, with regard to NGU, you have a negative test for chlamydia which although it does not cause all NGU is an important possibility to have ruled out.  

4) Does my previous positive HSV2 result suggest my current symptom could be related to an outbreak in a new location?

No, if anything it makes this less likely to be related to HSV.  HSV tends to recur in about the same location.

5) Do you have any alternative diagnosis such as chronic prostatitis, kidney stone, or high BP (142/93 yesterday)?

Only as I've mentioned above.  I hope these comments are helpful.  EWH