Sexually Transmitted Diseases/Single Lesion on Penis

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Question
herpes or normal digital trauma
herpes or normal digit  
Hi,

I am have been in a monogamous relationship for 4 years and have had no previous infections with an STD or STI. 4 weeks ago I had unprotected intercourse with a girl I don't know during a wild night. We had vaginal and oral intercourse 3 times throughout a 12 hour period, all while intoxicated. The oral intercourse was performed on me intermittently throughout sex. Afterward, she assured me that she had never been diagnosed with any STDs/STIs and that she had only had 2 partners in the last 4 years.

Twelve days after the event I began to have an uncomfortable but not painful tingling sensation in my urethra that began a day after my girlfriend performed oral sex on me. Two weeks after my unprotected exposure I saw my provider and was given a clean-catch urinalysis for chlamydia, gonorrhea, syphilis and another for UTI causing bacteria such as ecoli and a blood test for HSV and HIV. All tests came back negative. But the uncomfortable sensation in my urethra continued, and my provider suggested that it may have been psychosomatic or a neuralgic manifestation of guilt.

Nearly 4 weeks after my exposure, and many other trips to the clinic to have "would-have-been" cold sores, genital abnormalities and the like examined (only to be reassured and nearly laughed at for my neurosis) i developed a raised red area, not a blister, on the underside of my penis shaft. This weekend I have manipulated it and picked at it so much that I've irritated the hell out of it to the point where now it looks like a legitimate herpes lesion. I have been taking a gram of Valtrex every day to prevent an outbreak while I'm with my girlfriend until I can get sufficient negative blood tests back. But now this? Is this what digital trauma can cause? Or should I be concerned now with a very real herpes outbreak. It would be my primary.

The picture above was taken after vigorous cleaning and drying of what I worried was the straw-colored lesion cover, but what may have been, and hopefully was, a regular scab. Light colored in nature due to constant cleaning and washing.

Thanks again.

Answer
Hello Winston,
You don't have herpes, and you should stop taking an antiviral that has no benefit since you aren't infected. Stop picking at the skin. It does not look like a "legitimate herpes" lesion.  It looks like it might be a skin infection from a skin fungus. Apply a topical antifungal such as terbinefine, tolnaftate, or miconazole and it probably will get better in week or so. Stop obsessing about an STD that you don't have.

Good luck!
--mark  

Sexually Transmitted Diseases

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Mark P. Behar

Expertise

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!

Experience

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.

Organizations
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)

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

Education/Credentials
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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