Sexually Transmitted Diseases/Is this HSV 2

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Question
Hey Doctor, I am an uncircumsized male and recently had oral sex a few weeks ago and shortly after noticed a itchy red bump on my penis. Unfortunately, I began to scratch at the bump and the surrounding head of my penis. A few days later I noticed several bumps around the head of my penis and that the initial red bump had scabbed and healed away. Initially there were no symptoms from the bumps but lately they have begun to tingle, itch and burn causing a bit of discomfort. Also I have noticed that I will on occasion get headaches, pain in my buttocks and sharp pain in my anus.  I was told from a free clinic counselor that Hsv 2 bumps or sores will come and go within the first 2-3 weeks. It has been six weeks now and the symptoms are still the same. Can you please offer some guidance as to what this might be?

Answer
Hello Devin,
Herpetic ulcerations usually develop and heal up within a 2-3 week time period. Of course they may recur, but each episode lasts no longer than that time. You didn't mention where the itchy bump was-- on the head (glans) underneath the foreskin, on the foreskin, on the shaft, etc. You didn't mention if you have any other skin conditions, or if you use any medications for any purposes, or have any contact exposure to new  cosmetics, chemicals at work, and so on.

There are lots of skin conditions that may be responsible, but more information and photos would be helpful. Scabies, folliculitis, pimples, staph infection (with or without MRSA, methicillin resistent staph aureus), eczema, psoriasis, etc.

The headaches, buttock and anal pain all seem to be related to other, unrelated things, including muscle strain, constipation, sinus infection, toothache, etc.

Visiting a health care provider is designed to sift through all this information to refine possible causes.  My guess is that you have several unrelated issues, than all can be easily addressed.

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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