[Question #1250] HPV, Fungal Infection or worse?

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93 months ago

I’m a 36 y/o male and have read through multiple threads on this site trying to identify what I might have.  The information can be confusing.  Thank you for what you do, I think it is a great service.  About 18 months ago, I had unprotected intercourse that was extremely brief.  Approximately 10 days after the encounter, an ulcer appeared on my scrotum.  I panicked and applied anti-bacterial hand sanitizer to the ulcer and it scabbed up and disappeared in 5 days. A few weeks later, another ulcer presented and was handled in the same manner with the same outcome.  I have not had any ulcers since, but I have had fairly constant symptoms in my genitals areas from that point forward. I have had constant burning, itching, pinching, crawling sensations in my pubic region, groin folds, penis, scrotum, perineum, anus, and thighs.  The symptoms will change from mild (almost unnoticeable) to severe (almost unbearable) and back and forth.  It has been happening like this for the past 18 months. I treated it as jock itch to no avail using otc miconazole and clotrimazole.  I thought it worked after 5 days of use, but the symptoms resurfaced after the 5th day.  I was tested for STD’s at 1 month and 12 months post encounter with all results coming back negative. Recently, I noticed a spot on the shaft of my penis that looks just like a Fordyce spot, but is a little more pronounced than the others.  I keep checking my scrotum and think I have found what looks like a wart only to check again later and be unable to find it.  Is this HPV, a fungal infection, or something worse and do any of these have symptoms that last this long and are constant?  Thanks for your insight.

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H. Hunter Handsfield, MD
93 months ago
Welcome to the forum. Thanks for your question.

I'll try to help. I'll start with the fact that the large majority of genital skin problems are not STDs. (On my bookshelf is a book titled Genital Dermaatology Atlas, and only 15 of its 300 pages and a small minority of photos deal with STDs.) Most genital skin problems are dermatologic conditions that can occur anywhere and happen to involve the genitals. Others are genital specific, but still not sexually acquired or transmitted.

As for your situation, you symptoms are not suggestive of any STD. That includes all the specific STDs youmention, including HPV. There are no STDs that cause "constant burning, itching, pinching, crawling sensations in [the] pubic region, groin folds, penis, scrotum, perineum, anus, and thighs." Further, all the standard STD tests are highly reliable, so you can be confident you don't have any of those for which you were tested. Certain fungal or bacterial infections, allergies, eczema, and other common skin problems conceivably could be responsible.

The one issue that suggests possible STD is the ocurrence of scrotal ulcers not long after the sexual exposure mentioned. However, the only STDs that cause genital ulceration are herpes and syphilis. Neither is likely to cause initial symptoms on the scrotum; both typically need to be "massaged" into exposed tissues and hence occur primarily at sites of maximum friction during sex, which generally doesn't include the scrotum. And as already implied, your other symptoms are not suggestive of either syphilis or herpes. That said, for reassurance about them, blood tests can be done for both HSV and syphilis. For all the reasons given, I would expect negative results.

You don't mention any doctor visits, but presumsbly you have seen one or more physicians. What did they say?

At this point, the best I can suggest is first to stop all attempts at treatment of any kind. Also stop the compulsive self examinations. Whatever the primary problem might be, many of your symptoms suggest that you are now hypersensitive to trivial symptoms that you otherwise would ignore, or even normal body sensations, all magnified by anxiety. The same psychology can lead to seeing things that are hard to find later, probably because they were trivial or meaningless to start with. Assuming symptoms continue after a few weeks of no treatment and hands off, seeing a dermatologist would make sense.

In the meantime, don't be worried. Whatever you have, almost certainly it isn't serious or dangerous, i.e. nothing that will ever harm you or a sex partner. This sounds like an issue strictly of comfort, not danger.

I hope these comments have been helpful. Let me know if anything isn't clear.

Best wishes--  HHH, MD