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Sexually Transmitted Diseases/Small red spots that turned into small craters/ulcers?




Been with a long term partner for years now. Around two weeks ago I noticed a couple of red spots appear on the head of my penis, they didnt really cause any pain or discomfort. Then after a few days it started to feel very tender as though the head was swollen slightly. About 2 years ago I had what I believed to be the same symptoms and saw a doctor who said it was thrush and prescribed canisten. So I got some of this again and started to use about a week ago. Now the small red spots have been replaced by small crater like uncles which have a wet looking centre and are very sore to touch. I don't remember getting these last time although I do remember a small amount of discharge from the effected area last time. There is no itching or pain while urinating, just the sores on the head of my penis.

Hope you can help. Thank you.

Hello Neil,
The genital ulcer condition you have requires a viral and bacterial culture as soon as possible to determine exactly what the causative agent may be. I suspect that it may be herpes, which can be transmitted from oral, vaginal, or anal sex. Chancroid is possible, but it is very uncommon, and usually it causes only a single large dirty looking ulcer. Syphilis may cause a chancre, but this is a nontender and indurated, "clean looking" ulcer. A blood test may help in the diagnosis of syphilis, as most clinics do not have the ability to conduct a "dark field" examination directly from a specimen from the lesion.

The quickest thing to do is to get tested, and then request antiviral treatment (with acyclovir or valaciclovir).  If you don't have herpes, no harm done. If you do, it may help to speed healing.

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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