Sexually Transmitted Diseases/Herpes, Hpv, or infection?


Taken July 25th
Taken July 25th  

Test Result
Test Result  
Hello, I began getting redness on my penis head and later strange injuries after sexual activity for about 2 months now. Used yeast medication (diflucan pill) and (miconazole nitrate vaginal cream usp 4%)for a week or so as it looked like a yeast infection but it didn't seem to go away. After that didn't work I took antibiotics (Amoxicillin 500mg) for 7 days and used a triple antibiotic tropically in-case it was bacterial infection. Thirdly I tried using Cortizone in case it was a dermal issue like eczema. Took a full std blood/urine test 4 weeks ago and was negative in everything but herpes which came out equivalent. I don't have insurance and the test was expensive so not sure what to do now. When it's dry the bumps flatten out and when it has moisture they raise up and turn white. Can anyone tell me what I can try to get rid of this? It does not itch, burn, or hurt and I don't have any other symptoms.

More pictures taken this week:

Hello Jake,
Sorry you ended up with a health care provider who tested you needlessly for several things. Your tests were:
Herpes 1 IgG antibody  REACTIVE; this measures antibody from any past infection but NOTHING acute.
Herpes 2 IgG antibody  Negative; this measures antibody from any past infection but NOTHING acute.
RPR antibody  Nonreactive; this measures evidence of syphilis of at least 2 weeks or so past the primary stage (but does not detect incubating syphilis)
HCV (hepatitis C virus antibody) Nonreactive; this measures evidence of hepatitis C, which is totally unrelated to penile lesions!!

The proper tests would have been herpes type 1/2 NAAT (a DNA test to detect presence of herpes simplex 1 or 2 virus, NOT ANTIBODY); a wet mount to detect presence of skin fungi; and a syphilis test, which was correctly ordered.

The photos show an uncircumcised penis with unkeratinized skin worn away from the glans, probably after aggressive washing and fussing over, showing underlying redness. You probably have balanitis, inflammation of the foreskin and glans, and the most common cause is 1) yeast; 2) not as common, HSV (herpes type one or two); and possibly a human papilloma virus (HPV) which would not really cause balanitis, but might cause the elevated white lesions that you detect.

Although you treated yourself with diflucan, it probably won't work on the penis. You treated yourself with a vaginal yeast cream, which is pH adjusted to work inside the vagina (an acid environment), not under the foreskin (which is an alkaline environment)-- miconazole vaginal. My usual favorites would be miconazole (Micatin), which is pH adjusted for skin tinea (pH ~7), or terbinefine (Lamisil), or tolnaftate (Tinactin), all of which where athlete's foot medications and antifungal SKIN creams & powders are sold at the drug store.   

The antibiotic pill and ointment were worthless and potentially dangerous, since the skin can be sensitized and have a reaction to some topical antibiotics containing neomycin, a common ingredient in "triple antibiotic" cream/ointment. And the cortisone is both too weak and ineffective for use on the penis, and shouldn't be used unless carefully prescribed by a knowledgeable health care provider, as certain long term and permanent alternations of the skin can occur if used excessively.

What I would do is gently wash the skin daily with plain water and pat dry; when urinating, pull back carefully, and then dry the head so no urine is left to "fester" under the foreskin. Avoid sex until fully healed, and if you must have sex, use sufficient silicone lube (not water soluble which drys out too fast, and oil based, which may damage condoms).

Hope this is helpful!  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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