Sexually Transmitted Diseases/Herpes or some other std?


QUESTION: Hello Mark,
I am a 27 year old male from New York City. I had unprotected sex with a stranger 17 days ago- intercourse and I performed oral on her.
2 days later the following symptoms started:
Chills but no fever, severe itchiness all over my body, muscle aches all over my body, and some sweating.
6 days later I had severe pains in my lower back, lower abdomen and legs. I also had a slight pressure and tingling in my groin and on my tongue. I had really itchy eyes at day 4 and 5 but that went away. Also, I couldn't sleep for more than 2 hours without waking. When I would wake my I would be disoriented and I would be numb and shaking uncontrollably. I haven't had definite lesions yet. By the middle of the second week these symptoms have mostly diminished. I still have aches in legs, mostly the left. My tongue has become hairy and white and still a little swollen. It also has small red dots at the tip of which I’m not sure if they were there before the incident but they aren’t changing size.  My penis glands get itchy or sore for about 20 mins a day but then subside and I feel occasional itchiness in the whole area. I haven’t seen definite sores but my penis glands have developed demarcations that I am concerned about. Pictures are attached.
I took an blood and urine std test 3 days after the sex and It came up negative for everything.
After the first week I went to my doctor and she didn’t think it was viral and gave me 3 anti-bacterial meds that I had to take twice a day for 10 days.
After my symptoms of tremors occurred I went to a second doctor who said I could have been reacting badly to the meds and prescribed me the anti-bacterial Azithromycin which was one dose. I showed him my penis and he didn’t think the demarcations were herpetic.
Right now I am still occasionally get chills, my groin is sometimes itchy and my penis head slightly burns occasionally (not when I'm urinating), my leg still aches a little, and my tongue just doesn’t feel right.

My questions are:   

1) Could my symptoms be something else other than herpes?

2) If lesions don’t develop to get a culture, should I be taking antivirals anyway? Should I demand them from my doctors if I don’t have visible lesions? I don't have insurance so I don't want to waste trips to the doctor.

3) If I caught herpes could I have also got it on my tongue?


ANSWER: Hi James,
Your uncircumcised penis has an indentation on the glans (head), which may be from a an injury (past or recent), or from a healing sore from syphilis, herpes, recent traumatic injury, or something from long ago, but never noticed til now. Your tongue looks normal. The multiple and unnecessary antibiotics were prescribed by doctors who did not have an accurate diagnosis. They INAPPROPRIATELY treated something that they didn't know how to treat!  

You mentioned having blood and urine tests that came up negative "for everything." No such tests exist. It would be helpful to know exactly what the tests were for: syphilis, herpes types 1&2, hepatitis A & B, gonorrhea, chlamydia, trichomonas, hiv/aids, hpv/warts (this last one might require a biopsy).

Your symptoms may be associated with acute viral syndrome (like influenza, or herpes), which accounts for your fever and chills. The consequences of your excessive antibiotic prescriptions are a yeast or tinea infection, which disrupts the body's protective mechanisms.  It also may disrupt the normal germs in your digestive system that can cause diarrhea, and in some cases colitis, which can be life threatening.  Skin fungal infections may cause a persistently itchy rash in the groin or elsewhere.

I think most of your symptoms are from skin fungal infections. In the absence of a specific diagnosis of some sort of viral infection, I would not recommend taking antiviral medications. If you "caught" herpes, it would usually not affect your tongue, but it might; usually, it affects the nose, corners of the lips, or anogenital area, but it can affect other areas of the skin, including the inside of the mouth such as the tongue.

You really may benefit from talking with a single, trusted health care provider. "Talking with" are the two imperatives!  

Good luck!

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

neck rash
neck rash  
Thanks for your previous answer.
Just a follow up:
Two weeks after the encounter, flu like symptoms remained but I was getting episodes of extreme itching, burning, and pain in my groin/penis and anal region. I also had some penile discharge. There are bumps in my nostrils that hurt are not going away. There was one pinhole dot on the shaft of my penis that appeared and hurt but went away after two days. I couldn't get to the doctor in time to culture it but I've been to three doctors and none could determine the cause. Igg tests at week 1 was 4.2 for hsv1 and .1 for hsv2. I guess that means I've had hsv1 for a while, however, I don't recall ever getting any cold sores. Retesting at week 6 showed an igg of .1 for hsv2. Now, seven weeks after exposure I still have achy flu like symptoms and have slight itching around my groin and all over my body, mostly arms and legs. I wake up with cold sweats and my tongue burns most of the time. I also have gotten a rash on the back of my neck of which I've attached a pic. It does not itch or hurt as much as other parts of my body but has been on my neck for 4 or 5 days. As for trusted health care provider- I don't have insurance and the doctor that I trust the most costs 200 a visit. So...

1) Can this be anything other than herpes? I thought maybe shingles but it is not on one side of my body. I requested antivirals to see if they would have an effect from the last doctor I went to after the neg test and he told me no and that I would have to "tough it out."
2) If not, what?
3) Could it be mental? I am a professional student and under a considerable amount of stress. However, symptoms like the discharge make me believe its physiological.

Any insight would be greatly appreciated.

Hi Again, James,
As this is flu and upper respiratory virus season, I cannot distinguish a common viral syndrome-- many acute viral infections all have these types of symptoms-- fever, chills, sweats, fatigue, muscle aches, nonspecific rashes.   

The itching and burning of the skin can be due to lots of things-- angioedema, contact dermatitis, skin fungi, allergies. The pain in the groin from constipation, or hemorrhoids, or prostatitis. Penile discharge from constipation, urethritis, or prostatitis. The bumps in your nosterils may be due to MRSA.  

This does NOT SOUND like herpes, or shingles. Antivirals, like antibiotics are inappropriate without a diagnosis. Stress does crazy things to people. You may have a viral infection, but instead of STDs like herpes, what about infectious mononucleosis (caused by Epstein-Barr virus)??

Sorry, I wish I could help.  You may seek health care from a community health center located in many areas around the country; they provide low cost health care to those without insurance.

Good luck!

Sexually Transmitted Diseases

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Mark P. Behar


Almost any question or concern about gay men's health issues, sexually transmitted infections, abnormal Pap smears, anal cytology (anal "Pap smears"), etc. 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 “pre-screen” 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 consequences 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!


Family Practice PA since 1981; Volunteer Clinician for Brady East STD (BESTD) Clinic, Milwaukee, since 1977; answered 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.

Co-Founder, Lesbian, Bisexual, & Gay Physician Assistant Caucus of the American Academy of Physician Assistants, Inc.; American Academy of Physician Assistants; Wisconsin Academy of Physician Assistants; National Co-Chair (2012-16), National Association of Black and White Men Together: A Gay, Multiracial Organization for All People (NABWMT)

Journal of the American Academy of Physician Assistants (JAPA) Q Visions, Quarterly Newsletter of the NABWMT

Bachelor's of Arts, 1972 (University of Wisconsin, Milwaukee, WI) Graduate Credits Experimental Psychology, 1972-75 (Tulane University, New Orleans, LA) Physician Assistant, Bachelor's of Science, 1981 (George Washington University, Washington, DC); Masters in Physician Assistant Studies, 2000 (University of Nebraska Medical Center, Omaha, NE)

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

Past/Present Clients
Brady East STD Clinic, Milwaukee, WI Milwaukee Health Services, Inc. (Martin Luther King Heritage Health Center), Dept. of Family Medicine and Early Intervention Program for HIV Infected Persons

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