[Question #1494] Please give me your advice on possible STD

47 months ago

Hi Doc,

 I am an older guy who got hooked up with a swinging couple. The woman performed oral on me for about 20 seconds. About two weeks later I develop two red spots on the front upper shaft of my penis. I keep it trim there and the hair was stating to grow back on the upper shaft where the red spots or [bumps] were. I could see NO fluid associated with them and they were spaced about ¾ of inch apart. They were entirely painless and the slightly bigger one had shiny look to it. I could however feel a little thickness under the bigger one but no broken skin or pimple head just smooth and flat. The smaller one took 2.5 days for the redness to go and the bigger one 4 days but being fair skinned I could still see evidence of where they were and could feel a little bump [or thickness] under the skin of the bigger one for a couple more days then they were gone.

About a week after that, my penis got tender on the back side of the head including the tip. It simply felt like sensitive nerves but NO discomfort while urinating. During the next week, the sensitivity on the head subsided the tip seems just a little sensitive when I think about it.

Tested at the  STD clinic and I am NEG for, HIV, Syphilis, Gonorrhea and Chlamydia. They did not find any swollen glands during exam.  They said to wait another month before I take the herpes test. I also went to a urologist and he could find nothing. He said he didn’t know why my penis was sensitive but said the lesions I described did not sound like herpes.  Everything is gone now but I am worried about passing whatever this is on to my grand kids especially herpes they are very young

Thanks


Edward W. Hook M.D.
Edward W. Hook M.D.
47 months ago

Welcome to the Forum.  I'll be pleased to comment.  The lesions you describe sound more like folliculitis than herpes or any other STI.  Folliculitis occurs when the microscopic pits in the skin that hairs grow out of become plugged and normal skin bacterial cause a reaction which may appear in any way ranging from red bumps to small pimples.  There does not need to be a visible hair present for this to occur.  Folliculitis is more common after shaving which predisposes hair follicles to become plugged and tends to go away with soap, water and gentle washing.  In contrast, herpes lesions most typically form small, fluid filled blisters which spontaneously open up.  Often but not always they are uncomfortable.  In your case, the fact that these lesions appeared following receipt of oral sex also tends to weigh against the diagnosis of herpes as more than 60% of adults have already been infected with HSV-1, the virus that causes cold sores (whether they know it or not- most people with HSV-1 do not know it). 

I will also urge you not to pursue this with a herpes blood test.  As it happens, this very week, The Journal of The American Medical Association (JAMA) will publish official recommendations from the U.S. Preventative Services Task Force and an accompanying editorial that I wrote both recommending against blood tests for herpes in most people because of problems with test performance (questionable sensitivity, high rates of falsely positive results).  In situations such as yours, unless the lesions occur at which time further evaluation is warranted, I recommend against the HSV blood test.  Even if it were positive, you would not know if the result reflected recently acquired herpes or prior herpes that you did not know you had (most Americans with either HSV-1 or HSV-2 do not know they are infected).

 For all of the reasons above, I would advise you not to worry about this unless the lesions recur.  If that happens, it would be farbetter to seek a HSV-PCR test than to pursue the diagnosis with a blood test.  I hope these comments are helpful to you.  EWH

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47 months ago
Thanks for the reply,
I should have told you last year I tested for all STI including HSV 1&2 all came back Neg.  Just a few follow ups
1-Do you think the tender penis head is related?
2- If this was genital HSV 1 would I pose a threat to my family?
3- A you say most HSV are fluid sacks would the fact that there was a firmness to one of the spots indicate fluid under the skin that simply did not rupture?  

Thanks Dr.
Edward W. Hook M.D.
Edward W. Hook M.D.
47 months ago

1  No, I do not think your penile tenderness is related.

2.  There is no reason to think it was genital herpes of any sort.  If it was, the only risk would be to future sexual partners.

3. No the firmness you describe does not suggest herpes and does not suggest the presence of fluid.

EWH

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47 months ago
Doctor, I have not described one of the lesion properly. Reviewing my post I fail to tell you that the slightly bigger one that was shiny also had a slight divot or concave in the middle. I have read about ulcerated HSV lesions and this is worrying me. I originally thought it might be syphilis because of the dimple and being painless and flat. There was never any form of fluid or pain and it stopped being red in 4 days . The other one went away in 2.5 days  I am stressed out for fear of passing something to my young grand kids with a peck on the forehead etc. My wife and I have no sex so that is not an issue. Thank you for your help.
Edward W. Hook M.D.
Edward W. Hook M.D.
47 months ago
When herpes lesions ulcerate they are clearly open sores, not indentations in a lesion such as you describe.  Further, when persons acquire herpes, they typically have multiple simultaneous lesions.  What you are describing does not sound like herpes or syphilis.  It could be molluscum contagiosum which is a minor viral infection which can be acquired in many ways including sex (it is also common among kids, spread from person to person through casual contact occurring in the course of play.  Given your anxiety, if it persists (molluscum would), you may want a dermatologist to take a look BUT what you describe does not suggest syphilis or herpes.  Further, casual contact with your grandkids is not going to give it to them.  Please try to relax.  EWH
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47 months ago
Ghezz ,thanks Dr and on a Sat.

Summarizing my situation,  Oral sex couple weeks before,then two red  spots upper shaft about 3/4 inch apart, basically flat, painless no fluid etc., one with a small dimple in it and shiny. Red gone in one of them at 2.5 days  other 4 days , took another couple of days for them to completely vanish, have not returned. tested neg for all std's did not test for herpes. 

Thanks again Dr  I have followed you for years Have a safe and happy holidays
Edward W. Hook M.D.
Edward W. Hook M.D.
47 months ago

Your summary agrees with my reading of your posts.  One last time, I urge you not to worry further.

Forum guideline call for up to three replies  per question.  This thread will be closed later today.  Take care.  EWH

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