Sexually Transmitted Diseases/HSV 1 or Eczema or ???

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shaft
shaft  
Hi there.  Thanks for providing this service.  I've been in dire straights trying to find answers.  I'm 44 bisexual male, sexually active, multiple partners but safe play 100% of the time. I'm routinely test for STDs for peace of mind. As far back as I can remember, I've been + for HSV1. Don't remember oral lesions as an adult...but have levels of 1.31 since at least 2006/7.

In Jan of this year, I noticed what looked like a small round lesion on the bottom side of my penis shaft. No pain, itching, etc. I thought is was nothing, maybe irritation due to a boxer snap, or a zipper cut but panicked when I also developed rectal irritation and burning. I went to an STD clinic in the area and on observation - doc said "looks like herpes"...again, all the tests were neg except for HSV1 when came back 3.18.

I then also found a site that could do a culture and had the rectal irritation area evaluated. The new doc said he didn't think it was HSV1 but swabbed and cultured.  Again, swab culture was negative.

So over the last couple of months, I noticed what appears to be a red patch of skin on the top near the base of the shaft. Pic attached.  The area does not hurt, resemble a blister, nor weep.  The area responds well to steroid cream (prescription or over the counter).  Last time, the time to resolve was about 3 days and I added aquaphor. No more lesions on the underside of the shaft.

Just not sure what to assume is going on.  Everything a read is confusing...and sometimes I think I hyperfocus way too much and see things that are not there. I know the skin of the penis is variable in color...

Advice?

Answer
Hello Frank,
Your story is somewhat confusing. You have a positive herpes 1 antibody test, but no evidence of a direct HSV test demonstrating actual virus.  Then you mentioned a rectal irritation, a common variation caused by lots of things, including hemorrhoids, contact irritation, a condition known as pruritis ani, skin fungus, herpes, and lots of other things. You didn't mention whether you ever bottom during anal sex (anal receptive), or if you do, what type of lubricant you may use; whether you use any medications for any reason.

The fact that the penile skin lesion responds to a steroid cream and does not resemble a blister, etc., is good, and suggests it is NOT due to a sexually transmitted infection.

My guess is that using the steroid cream will probably be effective, as long as it is not overused. Sorry I can't be more helpful.

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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