Sexually Transmitted Diseases/Rash for 3 months!!


QUESTION: Thank you in advance. About three months ago I had unprotected sex with my gf for the first time. The next morning she said she had pain and went to the dr. She was diagnosed with a UTI and yeast infection. I didn't think anything of it. A couple of days later I noticed signs of jock itch. About two weeks later I noticed that the skin between my penis and my scrotum was slimy and sticky and thin. No itch or pain. I went to bed and when I woke up there was a small ulcer on the underside of my penis where it was slimy. It was dark and that's the first time I remember seeing anything. Went to the dr who said he couldn't culture it because it was healing but it started like that. He injected some cortisone in. Next morning my entire scrotum was inflamed, scaly and had a really foul odor. The underside of the penis showed some painless bumps that seemed pretty deep. I went to a derm who said I definitely had yeast but wasn't sure about the penis bumps. He gave me a one time diflucan. My scrotum turned bright red from this and the penis got a psoriasis looking rash where the bumps were. After a few days it started to all dissipate with some itching and scabs but the rash on the underside continued. His whole process took a couple of weeks. The derm had me use cortisone and monistat on the rash and eventually after 2.5 months it began to disappear but not completely. The derm performed a punch biopsy that came back as "psoriaform dermatitis". After a couple more weeks it was pretty much gone other than a scar where the original ulcer was and a scar from the biopsy. I started having sex again and after the first time, the skin where the ulcer was became red and sensitive. I didn't touch it for a few hours and it stopped burning and the red went away. It seems this flares up now whenever I apply friction to that spot. Not sure if its just sensitive because its scar tissue or still remnants of this crazy rash. I am still very much concerned that its herpies for no real reason other than the fact that it hurts and has been there for three months in some form or another. I saw three different derms and a urologist and none gave me a conclusive diagnosis. I can upload a photo from when the penis rash was at its worst. Please let mem know your thoughts. I am losing my mind after three months of sores, rashes, bumps, burning etc.

ANSWER: Hello Jim,
I'm sorry to hear about this uncomfortable and unfortunate situation. First, I would venture  a guess that your partner was about to get her urinary infection and yeast before you had sex with her. Her symptoms coincidentally occurred the next day, which sometimes does happen. Initially, you have have had jock itch from a skin fungus, but it did not sound like herpes. The swelling and moist discharge may have been due to yeast. The ulcer could have been due to herpes, or syphilis, but doesn't seem likely, and both of those conditions usually occur without a secondary infection with a skin fungus. The punch biopsy demonstrated psoriasis, a chronic and recurrent skin condition that may occur in other parts of your skin.  "Psoriaform dermatitis" is a way some histologists and pathologists describe biopsy tissue samples under the microscope.

The fact that none of the specialists you saw gave you a definitive diagnosis is unfortunate, but sometimes they can tell you what it isn't more than they can tell you what it is. That is a function of the imperfection of existing tests, including biopsies. If you recall what they did tell you, perhaps I can translate.

Although I understand this is very annoying, it requires clear communication between your physician(s) and you.  If the diagnosis is indeed psoriasis, than there are effective medications to get that under control. If it is yeast or some other fungus, than there are a bunch of different creams that may be effective, however realize that many fungi are becoming resistent to commonly used medications. So if after a week or two there is no improvement, than ask for a different product.  I have personally found that the topical over-the-counter cream products terbinefine (Lamisil), tolnaftate (Tinactin), and miconazole (Micatin), are useful.

Good luck!

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QUESTION: Thank you so much for your prompt response. I had a blood test taken for herpes after 2 weeks from exposure and came back negative for herpes 1 and 2. I know this was too soon. None of the derms thought it was herpes.  They said for sure I had a bad yeast infection in the scrotal area which makes sense based on what my now ex-gf told me.  She assured me that she has been tested for everything and does not have herpes. I think this situation ultimately led to the end of the relationship. One derm said intertrigo and the others thought it was a secondary bacterial infection under the penis. It looked to me like it started under the penis though at the ulcer and then spread from there. The ulcer seemed to be more of a cut out of the skin than an actual cut. Kind of like a punch out. It was dry. There was some pus as well. Does the photo look like herpes??  I'm just freaking out after three months.  Why is it gone but still getting irritated and red in that one spot? Thank you.

Hi Again, Jim,
There are several different blood tests for herpes, and if you had the wrong one, it might come out incorrectly negative.  There is IgG (long term antibody) and IgM (short term antibody) for herpes type 1 and herpes type 2. In addition, there are "qualitative" tests reporting "yes" or "no" to whether antibody is present at a certain level, and there are "quantitative" tests reporting the actual numbers or amount of antibody present. In addition, sometimes the tests are together as in herpes 1 and 2 IgM and IgG qualitative meaning if there is any short or long term antibody to either of the virus, it is reported as "reactive"  (yes) or "nonreactive" (no).  So you can see that there is a confusing array of tests. The doctors ordering should know about that, and should inform you thoroughly.

Have a negative blood test after two weeks would not be too soon for IgM, but definitely for IgG. But I don't know which tests were selected!  I would believe the dermatologists, since they are experts in this area.

Intertrigo is a bacterial infection that may cause a cellulitis, which can definitely cause swelling, itching, leakage of fluid, pus, etc.  It does not look like herpes at all.

Good luck!

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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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