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About Mark Behar
Expertise
Almost any question or concern about sexually transmitted infections, abnormal Pap smears, anal cytology (anal "Pap smears"), gay men's health issues. There is no such thing as “d/d free” or “clean” (free of infection), so why do so many of us deceive ourselves into thinking that some people are indeed totally free from a potentially infectious disease, like HIV, herpes, hepatitis, syphilis, chlamydia, warts, gonorrhea, etc., just because they say so? Clinical laboratory tests are not perfect, and having a “negative” or “nonreactive” test does not mean that a person is free from infection. Perhaps at the moment the test was taken, the person was uninfected; or, perhaps, the test wasn’t sensitive enough to detect presence of the infection. There is really no way that anyone can determine that they are truly “disease free,” and there are over a hundred of infectious conditions that can be spread without your knowing anything. Rather than trying to “prescreen” or “serosort” a potential sex-mate with deceptive questions that are impossible to know by today’s technologies, a wiser option may be to consider everyone infected with something, and either use appropriate protective measures (“safer sex”), or accept the responsibility and conseqences of possibly “catching” something from someone who’s hotter than expected (pun intended!). There is much research that supports the contention that an HIV positive person reliably taking HIV medications, and having an undetectable viral load, presents a lower risk for transmission of HIV than people who may think or say they are HIV negative, but are not. Food for thought!

Experience
Family Practice PA since 1981; Volunteer Clinician for Brady East STD (BESTD) Clinic, Milwaukee, since 1977; answer STD questions submitted to their web site. Professionally lectured at national and regional Physician Assistant and Nurse Practitioner conferences, and at national gay & lesbian health conferences on topics including HIV/AIDS, herpes, hepatitis, STDs, human papilloma virus (the cause of venereal warts), abnormal Pap smears, gay and lesbian health issues, among others.

Organizations
Co-Founder, Lesbian, Bisexual, & Gay Physician Assistant Caucus of the American Academy of Physician Assistants, Inc.; Wisconsin Academy of Physician Assistants; American Society of Colposcopy and Cervical Pathology (ASCCP); Board of Directors, National Association of Black and White Men Together: A Gay, Multiracial Organization for All People (NABWMT)

Publications
Journal of the American Academy of Physician Assistants (JAPA)

Education/Credentials
Physician Assistant Certified, since 1982; Masters in Physician Assistant Studies; Colposcopy Recognition Award, American Society of Colposcopy and Cervical Pathology (ASCCP);

Awards and Honors
Colposcopy Recognition Award (CRA), from the American Association of Colposcopy and Cervical Pathology; Distinguished Fellow, American Academy of Physician Assistants; Fellow, Wisconsin Academy of Physician Assistants

Past/Present Clients
Brady East STD Clinic, Milwaukee, WI

You are here: Experts > Teens > Health for Teens > Sexually Transmitted Diseases > std

Sexually Transmitted Diseases - std

Expert: Mark Behar - 10/31/2009

Question
QUESTION: i had indulged in mutual masturbation 6 years back after which i developed swollen scrotum and swollen lymph nodes.i have hyperpigmentation on face too. what it could be? i got tested for hiv and vdrl now and they came back negative. please help me. what test should i take? is there a need for lymph node biopsy? if so , can it reveal the cause?

ANSWER: Hello Dj,
None of these activities would be sufficient to cause you such a reaction from a sexually transmitted disease. You did not tell me what country you are from, or where you had sex 6 years ago, or whether the symptoms have since resolved. In certain tropical areas, for example, a certain parasite unrelated to sex, may cause such a reactive lymphangitis with lymphedema and swollen lymph nodes.

If you still have swollen glands, than yes, a biopsy may tell you everything is all right or not. However such a biopsy may not tell you what the cause of all this was. Blood tests may be more specific in this regard.

Good luck!
--mark

---------- FOLLOW-UP ----------

QUESTION: Hi mark,
Thanks a lot for your reply.I'm 21 year old male from India and I had indulged in mutual masturbation, i mean it was only jacking off, with my friend six years back. I'm quite sure that he did not have any std.And once i come into contact with goat's saliva on my penis. I suspect this might be the cause. is there any possibility of std as a result of that.? Back then , I mean before six years , I had penile discharge. You ve said blood tests are more specific.If so, a blood culture would reveal the causative agent?? Thank u

ANSWER: Hi Again, Dj,
Unless you have an allergy to goats or goat spit, or if the goat just ate something like a poisonous or sensitizing plant (such as poison ivy-- I don't know what poisonous plants are in India that goats may eat!), I cannot imagine why you developed some sort of weird reaction to this contact. No STDs from goats, as far as I know, however!

The penile discharge you noticed SIX YEARS AGO is history. There is no way to determine what that was. It may have been just prostatic secretions from stool pushing on the prostate.

Blood tests can determine the presence of antibodies to certain infectious viruses and germs. A blood culture is designed to grow out specific germs. You need to talk with a trusted, health care provider to determine what, if anything you may need to do. I suspect that nothing needs to be done now.

Good luck!
--mark

---------- FOLLOW-UP ----------

QUESTION: Hi Mark,
Thanks a lot. And I wanted to ask like is there any relation between a std and hyperpigmentation on face.The Elisa test( HIV 1 and 2) and vdrl came back non reactive after 6 years. can i rely upon these results? I heard so that antibodies to these std's ll be detected after three months of exposure.Could u please let me know what test might arrive with a conclusive evidence? I suspect there's a relation between the swollen lymph nodes and hyperpigmentation.And if there's any kind of std infection or so in my body, will it be shown up in my haemotology blood test?? I've a normal wbc count of 7200 cells/micro l and a normal esr of 4mm per hour.

Answer
Hello Again, Dj,
Hyperpigmentation ANYWHERE is usually, but not always, due to some mild or chronic inflammation of the skin. Sun tanning is technically a "hyperpigmentation." Hyperpigmentation is not just an acute rash, but something longer term. One of the signs of secondary syphilis is a rash, then when that rash goes away (and the disease progresses to another stage of illness), hyperpigmented macules (1-2 cm "spots") may persist. Since your VDRL came back nonreactive, as did your HIV tests, you can be certain that these are no longer issues worthy of your concern from an incident that occured six years ago.

Your white blood cell count and ESR (erythromycin sedimentation rate) are very non-specific tests, and if abnormal, must trigger additional tests to see what could be the cause. Since these are NORMAL, again, NOTHING to worry about. Ordinarily speaking, there is no relatioship between acutely swollen lymph nodes and hyperpigmentation.

You see, each one of these communication exchanges generates more uncertainty and more questions in you. That is why you must seek out the assistance of a trustworthy health care provider in your area, so that you may sit down and discuss all of your concerns at once.

--mark

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