Sexually Transmitted Diseases/is it herpes?

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Hello doctor,

I'm a 24 yo guy who just recently had sex. About a week ago. It was with a girl i met in the bar. She said she doesn't have any STD. We used protection. But after sex, when i looked, there was some slimy liquid at the root of my penis. It was on the skin and i wiped it off with a paper towel and then i removed my condom. didn't see any breakage on the condom. But after two to three days, I'm having red spots all over the penis head and under the foreskin. They aren't painful but they are very tingly on the fore skin. On the second day there were around 30 of them in a line from the tip of penis to top. then after two more days I'm having numerous spots all over.

I tried applying yoghurt thinking it might be yeast infection and it was recommened online. but no results.

Now i'm getting itching around the penis, say the bottom of my balls.

Do you think it is herpes?. Please help

Answer
Hello Don,
The slimy liquid may be just vaginal discharge that was at the base of your penis, not covered by the condom. Some condoms and their lubricants may increase the chance of some irritation of the skin underneath the foreskin.  It is not related to a skin fungus, but yogurt does not treat anything when applied topically. If it is sweetened at all with a flavoring or fruit, it may actually have enough sugar (such as sucrose) that skin fungi may worsen.  The live lactobacilli in many types of yogurt are not effective for any type of skin fungus as well.  This doesn't mean that you DON'T have a skin fungal infection-- you may, or you may not.

You didn't mention whether you had oral sex without the condom, or if you ever had herpes in your life.  The rash does appear to have several erosions causing those little "pits" or depressions on the skin, which may represent the early stage of a desquamative process on the head (glans) when in contact with something irritating (such as saliva).  

You may need to see a knowledgeable health care provider in your area to check more thoroughly, as an in-person exam is better than a photo.  In the mean time, keep the area clean and as dry as possible, and if itching persists, try an effective antifungal cream such as terbinefine (Lamisil) or miconazole (Micatin) applied to ALL itchy area for a week.

Good luck!
--mark

P.S.  You really think this advice was so unclear and uninformative? Really?!!  Please consult your personal doctor next time.  

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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