AboutMark 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
I have a white mark on my penis, im worried about. Its about 8 to 10mm across painless but raised ever so slightly. Ive tried using Canasten cream thinking it may be a fungal infection but a week later it has only shrunk ever so slightly. Any help greatly appreciated
Answer Hello Jimmy,
Thank you very much for the photo, which clearly demonstrates infection by HPV, the wart virus. You may need to seek the services of a doctor skilled at treating venereal warts. In the US, such treatments include:
1) Cryotherapy, which is a freezing modality that uses a compressed gas such as nitrous oxide to get a metal probe very cold; sometimes liquid nitrogen can also be used to freeze off the abnormal cells. This is a destructive or ablative technique; the body's immune system heals the injury, and everything should return to normal. Perhaps several weekly or bimonthly treatments may be required to get the desired effect, which is eradication of the wart and the virus. Cost of this varies from free to several hundred dollars (US) per visit because it is considered a procedure, which usually costs more.
2) Acid, such as trichloroacetic acid, that may effectively coagulate the abnormal proteins comprising the abnormal cells of the skin. This too, is a destructive or ablative technique; the body's immune system heals the injury, and everything should return to normal. Perhaps several weekly treatments may be required to get the desired effect, which is eradication of the wart and the virus. Cost of this varies from free to several hundred dollars (US) per visit because it is considered a procedure, which usually costs more.
3) Imiquimod (Aldara) cream, which is self applied three days a week at bedtime, and then washed off in the morning. This is an immune system modulator which allows your body's immune system to fight the viral infection. This may require treatment 3 days per week for up to 3 or 4 months to be maximally effective. Imiquimod costs about $100-$150/month in the US.
I usually recommend treatments one or three above, because when someone comes to my clinic with such a lesion, they wish to have something done immediately, and the freezing definitely does that. However the imiquimod is thought to have the best overall effectiveness, because it modifies the body's immune system in a positive way.
How does this effect your ability to have sex? If you wear condoms, it should be little or no problem, except for the immediate consequences of whatever treatment you chose. So if a blister develops after the freezing, for example, it probably would be wise to hold off of having any type of sex until the immediate healing takes place, over the course of a week or two. Then, resume sex with condoms.
You may have additional areas of wart elsewhere on your foreskin, or penile shaft. And what about your partner? They obviously needs to be evaluated fully also.
Hope this is helpful! This is nothing to freak about-- it is a common but nuisance skin virus that only rarely causes significant consequences, mostly to women who have it growing inside the vagina and on the cervix, where it can be the cause of precancerous changes there.
Good luck!
--mark
Post Script:
Since you are traveling, I would ask for a medication called IMIQUIMOD 5% cream (ALDARA 5% cream). They are sold in the US in single use packets but may be available as small tubes. If you acquire the product, a tiny bit is applied to the white area on the penile head at bedtime, washed off in the morning, three times weekly-- usually Monday, Wednesday, Friday, or Tuesday, Thursday, Saturday. Then, skip two days, and repeat. This is done for anywhere from 1 to 4 months, religiously. Redness and irritation are common side effects, perhaps with some burning. You may retract the foreskin after the medication is applied.
You didn't mention which countries you are traveling in, but even in many so called 3rd world countries, doctors are trained by excellent British, French, American, or German medical standards, and should be trustworthy.
