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Sexually Transmitted Diseases/Bumps and blotchy redness on head of penis

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Non-erect penis
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Hello,

About 10 months ago I began seeing a new partner. After discussing our STD status (both had recently tested negative for the standard set of tests) we begin having unprotected sex. A few weeks after this, she complained to me of some irritation in her vagina, and went to get things checked out. I didn't find out until much later, but the irritation turned out to be a yeast infection.

Around the same time as her irritation, I begin to notice slight blotchiness on the head of my penis, and it took on a bumpy texture when it was erect. When this first started, the bumpy area (primarily on the top halfway between the meatus and the base of the head) would become irritated after sex, sometimes showing bright red spots, and the head of my penis would feel sore.

I have spoken with 2 different doctors about this issue in the past 9 months, as the severity of things has lessened very slightly but the bumpiness and slight blotchiness has remained unchanged over this time. One was unsure of what was going on but doubted that an STD was the cause, and the other said my penis looked normal. Neither evaluated my penis when erect, which is when the bumpiness is most apparent. The second doctor prescribed me Tetraconazole and said I could try it out to see if it helped. I applied my first dose of it this afternoon.

I am confused as to what this might be. I have never experienced any sort of itching, discharge, or blistering. The irritation occurs only after sex or masturbation. From my understanding balanitis or other yeast infections often produce itching or inflammation, and I don't seem to be experiencing either of those. Can yeast infections present themselves without itching?

I have attached two pictures. The first (lighter) is of my penis non-erect. The redness is present, but it is hard to see the bumpiness. The second is of my penis erect, where the bumpy texture is much more apparent. Do you have any insight into what could be going on? Could it just be normal skin variation that I never noticed before and am overanalyzing?

Thank you for your time.

Answer
Hi Loren,
Yes, it does look like a normal variation in the skin.  Note, you are uncircumcised, and sometimes sex with inadequate or the wrong type of lubricant can cause irritation of the underside of the foreskin and glans (head)  of the penis.  Your partner's yeast infection may have also contributed a bit of irritation as well, but I don't think you have a skin yeast infection, so the tetraconazole probably will not be effective.

It's not that you have anything, but the irritation may cause a little redness or bumpiness, but this is not unusual, and nothing to worry about!

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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