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Sexually Transmitted Diseases/Skin changes and symptoms following first sexual encounter. STD?


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I am a 24 year old caucasian male living the UK. 4 weeks ago I had my first sexual encounter, protected oral and vaginal sex. 5days after the encounter I went to the doctor, who diagnosed me with NGU and I took the treatment. At the time I also noticed changes in my penis that I had not seen before. I showed it to him, but he suggested that the incubation period was too short for anything like warts etc to develop. He said they were normal skin variations. I am showing you these pictures here to get a second opinion.

Pictures A, and C are from the penis head. there are tiny protrusions that seem to look like warts but also like Pearly penile papules, i doubt that they are PPP because they are not at the ridge. I took pictures of them with skin stretched and with skin normal.

Also around the shaft of my penis I found these very tiny nodes, I had not seen before. I only noticed these recently.

Also since two days ago I have been suffering with a sore itchy throat and slight cough, do you think that this is in any way related to my sexual encounter 4 weeks ago. I am worried it is either herpes, ARS or possibly even EBV.

Any help would be greatly appreciated.

Hello Marcus,
You certainly have remarkable eyes to be able to detect such tiny bumps on your penile glans (head)!! Your doctor is correct, that they are normal variations in the skin, and are not pearly papules or warts caused by HPV.  The closer you inspect any area of skin, the more you may see, and this detail is usually representative of just normal skin variations as we age.  

No photo was of the shaft showing the "tiny nodes" you spoke of, so I can't comment on that!  Sorry.  The itchy, sore throat and cough are most likely due to seasonal changes associated with allergies (sinus drainage, for example), or acid reflux (heartburn) if you have that.  Not related to your sexual encounter.  There are many upper respiratory viruses that may contribute to your symptoms, all collectively known as Upper Respiratory Infection (common cold).  The herpes virus family of viruses includes herpes simplex 1 & 2 (what we usually refer to as "herpes"), but also EBV (Epstein-Barr Virus, CMV/cytomegalovirus, chicken pox/shingles/varicella zoster, and a few other herpes hominus viruses (HHV) in search of diseases).  EBV is the main cause of infectious mononucleosis, which is not an uncommon cause of infections in people in your age group, spread by kissing and sharing of saliva.)  Infectious mono usually causes a flu-like syndrome with fever and malaise along with the sore throat and swollen glands, which you did not mention.

The most likely cause of your symptoms are just a cold, sinus drainage, or allergy. Nothing to freak about!

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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