Sexually Transmitted Diseases/Spots on penis

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Question
Spot
Spot  

infection
infection  
Hi Doc.

I am 21 y/o and from south africa. I am a second year medical student.

I have this spots on my penis. I went to read up on it and the net suggested Fordyce's spots. My concern is that they are ALLOT and big and spread throughout my whole penis. This is also the third time in a year that one of the spots get infected. I am sexually active, but did not had sex for the past year. And before that I only had sex with my girl friend of two years, but she cheated on me. I am affraid that this is something more than just Fordyce's spots. The first infection was very bad, because I did not know what it is and thus it got bad. I drained about 10ml puss from it. About 4 months later I got it again, but drained it within a week. There was less than 3ml puss. 6 months later {now} I have another infection. I will sent a few pics with this. Can you help me?? Please email me if you need more pics. I can not sent more pics, but there in more spots. Even on the glans of my penis.

Thank you very much
Johan

Answer
Hello Johan,
One of the possible consequences of an uncircumcised penis may be bumps on the underside of the foreskin associated with fungi such as candida. I cannot tell whether these whitish bumps with floccular appearance can be gently washed off with water (avoid soap which may be irritating), or whether these bumps represent early punctate lesions associated with HPV infection (warts). When occluded, glandular openings can become retained cystic structures and infected like pimples. They may represent other manifestations of chronic skin conditions you may have but not apparent, or of medications (topical or other) adverse reactions. More information about your medical and sexual history may help to clarify.

Fordyce spots are not found on the underside of the foreskin, as they are characteristics of KERATINIZED  squamous epithelium and this skin is not keratinized.

I would clean your penis with plain water in the shower (no soap), and then apply some plain white vinegar for 30-60 seconds and then observe for whitish changes which might signify HPV. You may need to see an STD or family medicine specialist for management. Regarding the pimples, applying moist heat to the affected areas, followed by over-the-counter topical antibiotic ointments. Do not use a needle as this may cause deep tissue infection and scarring, which could affect  your ability to have sex normally.

Good luck with both your studies and your own skin!
--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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