Sexually Transmitted Diseases/Dark spots + red spot in glans

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Question
Before and after possible infection
Before and after possi  

Red spot
Red spot  
Hi, I would like to ask you about some spots I got on my glans:

About 3 months ago, I had unprotected sex with my ex-girlfriend. 2 days after that I found some red spots on my glans (as seen in the picture on the left).I had to move to another country so I did not have time to check for this (find a new house, job, etc). I settled down 7 weeks after and the red spots had spread to all my glans and foreskin (there were no sores/bumps neither discharge). During all that time I used clotrimazol/ketoconazol and fluconazole with no results.

After 8 weeks I went to see a dr. He was a really bad doctor, he saw the rash and said "It is herpes" (the consult lasted 3 minutes basically). I said that there were already 8 weeks and it lasted too long to be herpes. He prescribed tetracycline + cepradoxile and it worked! But these are antibiotics, so it would have no effect in herpes but in bacteria (am I right?)

After the red dots almost disappeared, three dark spots appeared in my glans (as seen in the picture on the right). I didn't have them before, and at the very top of my glans there is still one small red dot. I went to see a second doctor yesterday and he said it was a fungus and prescribed miconazole (but I already tried fluconazole without results).

Do you think this is a chronic bacterial infection? Or is it herpes? Why there was some relief with antibiotics but not with clortimazol (and ketoconazol/fluconazol)? I'm so scared that not even de doctors know what's happening. Thank you so much for your help.

Answer
Hello John,
You were correct in your assessments.  The clotrimazole, ketoconazole, and fluconazole are all three different antifungals collectively known as "azoles," and one of them should have been effective if you really had a skin fungal infection, which it doesn't look like. Tetracycline, etc. are in fact antibiotics which would have been useless against herpes, which you obviously did not have. It wasn't really appropriate to prescribe oral antibiotics for a minor skin infection.  Applying moist heat and a topical antibiotic cream or ointment would be just as effective, without causing potential side effects. Unfortunately, uncircumcised penises tend to develop friction related skin irritations (from sex, rubbing, masterbation, etc.).  

It is not a chronic bacterial infection, just an acute one that hasn't completely healed. Everything will eventually improve! Just give yourself some more time, with the topical antibiotic.

Good luck!
--mark  

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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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