[Question #2272] Follow Up

47 months ago
Hi Dr HHH/Hook,

This is a follow up to my last questions. Its been about 2.5 weeks since the last incident. I developed a rash on my buttocks. This was a single swollen circular mass in the morning so I applied a combination of fucidic acid + Clotrimazole which I had with me since I was traveling. By the evening the swelling "settled down" and has become a itchy/irritating red circle with little bumps. I reached home by evening and went to a skin doctor who is treating it for a fungal infection. He advised going ahead with Clotrimazole and anti fungal oral medicines.

In the previous question I had mentioned that I was concerned when the masseuse hugged me from behind while showering from behind. This was when I felt that she touched her groin on my ass.  Do you think could be anything else. The timing concerns me. FYI, during massage this incident I'd been traveling and flying for a week.

Best,
Roh.
Edward W. Hook M.D.
Edward W. Hook M.D.
47 months ago
 Welcome back to the forum. I will start my reply by reiterating what Dr. Handsfield has already said. There was no risk at all for any sexually transmitted infection related to the exposure you report.  Clearly you are anxious and perhaps feeling a bit guilty about the exposure and that is causing you to be overly watchful for signs of an infection that you are not at risk for.   I agree with your doctor that the rash you describe sounds very typical of a fungal infection. Cutaneous fungal infections however are not sexually transmitted.  They may occur by chance, or in relationship to other factors such as underlying diabetes or having taken antibiotics immediately before the end fungal infection appeared.  What they certainly are not however is sexually transmitted infections and I can assure you that the fact that your partner hugged you in the shower is not the source of your fungal infection.   This is a coincidence and nothing more. You really need to get a grip on your anxieties and guilt and stop wearing about STI's. 

 In addition I need to remind you that we do not except repeated anxiety-driven questions related to the no risk explain exposures. Such questions are of little help to our clients and of little educational value to others to visit the site.  I hope you will understand.  EWH
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46 months ago
Dr Hook/HHH, 

I have some symptoms which still continue. I have developed a pain in back (mostly right) which starts in the lower back, on the buttock and to upper part of my leg. I also have headaches near my right eyebrow, lower back of the head and in the ears.  Also I see small red lesions on by butt, waist and back. I wanted to add that my last experience was in Russia (which I found out had very high STD/Syphilis rates) - Does that change the risk assessment in any way.  I'm trying to move on but symptoms and discomfort are making it difficult. Are there bugs/parasites which you can catch from another person ?

Best,
Rohan
Edward W. Hook M.D.
Edward W. Hook M.D.
46 months ago
None of these symptoms raise concern for STI, including HIV.  You should look for other, non-STI causes of these problems.  Such symptoms can be heightened if a person is worried (i.e. feeling anxious or guilty).  EWH
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46 months ago
Hi Dr Hook/HHH,

Firstly thank you for answering my questions so far. I've decided to visit a psychiatrist to work with my anxiety, deal with this and get counseling on how to disclose all this to my partner ( I think she should know what she's getting into with me) and see if I have an addiction.  Also I want to visit  a venereologist to give him/her the full picture as I've been dealing with these problems with different doctors (social stigma/traveling for work etc.) though I'm not sure who this will be in India - dermatologist or urologist - I'm trying to find out - its difficult to find anyone here of your specific experience and specialization. I ask the following so that I can have a proper discussion with them, request any test/course of action if required with proper reasoning even if they don't belong to the exact specialization.  Also I think this will give my future wife a clear assessment of the risk factor. I've tried my best to ask pointed questions and apologies for the long post, trying to settle this once and for all

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Following are my exposures - 

[Period 1] Previous History (When I got tested) 
2013 - Relationship with a lady (5-10 partners)
Apr 2015 - Condom protected sex with CSW/ Massage girl
May 2015 - Hand-job from CSW/ Massage girl
Jun 2015 - Condom protected sex with CSW/ Massage girl
Nov 2015 - Condom protected sex with CSW
8th Jan 2016 - Unprotected oral and genital rubbing with CSW/ Massage girl

[Period 2]  Latest exposure
22nd May 2017 - Hand-job from CSW and hugging me from behind in shower (potential vagina rubbing against my butt)


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Symptoms/ Tests

[Period 1]

1st week Feb 2016 - Some warts/growths on hand and red spots on body - these were white/skin in color and went away in 2-3 weeks max  and had flu like symptoms (Treated for scabies) - this triggered panic in me
3rd week of Feb (6 weeks from the last exposure of 8th Jan) 
  • Tested for HIV (Result -ve) - PCR RNA and Duo Test - [QUES 1] I see from other posts that PCR + Duo after 6 weeks is conclusive for all previous exposures. Can you please confirm.
  • VDRL (Result -ve) - [QUES 2] I'm not sure if this covers all the above events in Period 1, does it cover my exposure 6 weeks ago on 8th Jan ? I heard that sensitivity is low for primary syhpilis in VDRL
  • Hep B - HSbAg test (None of the other 2 test for Hep B) - [QUES 3]  I'm not sure if this covers all the above events in Period 1, does it cover my exposure 6 weeks ago on 8th Jan and older exposures ?
2nd week Mar 2016 - Intense pain during urination and pain in genital area while traveling to the US. 

  • Tested for Clamidiya/Gonorhhea and Trich all came back negative. ( these were from 2 different visits) . [QUES 4]  Is this conclusive for all exposures 6 weeks before and older ?
  • The second doctor also ordered a urine analysis which came positive for E.Coli. which was resistant to most antibiotics except for 1  Oral and rest intravenous
  • Came back to India - Got the urine analysis done twice but they did not find the E.Coli. I had started working with a Urologist (30+ years experience) - He said that the E.Coli could be a contaminant and his diagnosis was Prostatitis - He put me on 6 weeks of Ofloxacin ( not in list of antibiotics recommended in the test in USA) - Also he said such long dose of Ofloxacin is sure to flush anything out.  [QUES 4] - Could this have been NSU ? Is ofloxacin recommended for that ?
  • The genital pain went away only to come back 1-2 times in gaps of a few months post which it subsided. The doctor asked me to ignore
2nd April 2016 - 13 Weeks from last exposure of 8th Jan
  • Tested for Hep C, Hep A and HSV 1/2 (CLIA test) - [QUES 6] All came back negative. Was it too soon to test for Herpes at 13 weeks and was this the right test ?
  • After traveling for a bit in the US,  I develop serious itching in anus/rectum.  Gastro  doctor observed my rectum though an invasive tool. He says small inflammations/lesions but probably due to fungal infections after a long Ofloxacin course and difference in toilet habits in India and US. He treated me for fungus. The serious itching went but I keep on getting mild itching. The only exposure I had was of a massage worker using oil to massage the rim i believe only once, no insertion and no wart visible outside. [QUES 7] - Should I get this re-evaluated for Warts/HPV ?
2nd June 2016
  • I went to play in a pool ( not a swimmer) and bought a new pair of trunks at the hotel. When I came out the foreskin of my penis (only the upper part ) seemed highly bruised by the inner mesh of the trunks and there were red lesions . I got panicked and applied a lot of dettol and the lesions began to blister. There was mild pain before applying dettol (http://www.dettol.co.in/en/products/search/antiseptic-liquid/) and a bit more afterwards. I showed it to a dermatologist who said it is contact dermatitis because of swimming trunks and perhaps high chlorine in hotel swimming pools plus I burnt myself by applying dettol without diluting the solution hence the blistering- she gave me a few  topical creams to put.  She did not think it was herpes.  I recovered in a week [QUES 8] - Could this be herpes ?
July 2016 
  • I had vision problems - started seeing straight lines curves on a computer screen. Went through rigorous testing - (macular degeneration/ keratitis/ field test etc.) and it was put to stress due to long time screen usage (i have a computer job) and allergies. The problem has slowly been resolving over a year and quite corrected but not a 100%. [QUES 9] - Do STDs have any eye manifestations like this ?
[Period 2]

2nd week of June 2017 - 
  • 2/3 weeks after the hand job and shower exposure in Russia I started saw a large bump on my butt. This was skin colored. I applied fucidic acid + clorimitrazole cream. This settled down by the evening /in a day and converted into a red circular area with small bumps. I showed it to a skin doctor and they said it was a fungal infections (or perhaps a bite) and treated me for both.
3rd week of June 2017 - 
  • I developed a stomach infection and aches  in my head (close to right brow, back of right side of head and below/in the ear) and in my back (I went to the office spa a few days back - all clean activities but the masseuse used a lot of force). The stomach infection was treated with Ofloxacin and Ornidazone combination. I got my eye checked which was fine so the headache was attributed to sinus and is being treated for that. 
  • The ache continues in my butt and lower back [QUES 10 ] - Could these be manifestation of syphilis or herpes or other STDs? I searched for rash and headache and found syphiis and Lyme's disease. Are bugs also transmitted during close contact such as sex ?
  • [QUES 11 ] - Would the ofloxacin+ornidazole interfere with Syphilis test if done at this stage (5 weeks from exposure) and should I test using VDRL or TPA.
General

[QUES 12 ] - Would my treatment of Oflox for 6 weeks work on M Gen and Chancroid. I think I was prescribed Azirthomycin 500mg for viral fever/flu last year as well for 3/4 days.

Best,
Roh










Edward W. Hook M.D.
Edward W. Hook M.D.
46 months ago
You are abusing our site, ignoring our guidelines on the accepted length of posts, asking redundant questions, and repeating questions about no risk situations. This will be your last reply and future replies will be deleted without comment or refund of your money.  Please do not return to this site.
1.  Correct
2.  Your result shows you do not have syphilis.  Believe the test.
3.  Yes, it covers your exposures.  Believe the result.
4.  Yes, results are conclusive
4.  You should believe your doctor.  Ofloxacin would cure most NGU
6.  We do not recommend blood tests for herpes but this result and your history indicate that you do not appear to have genital herpes.
7.  No need for re-evaluation.
8.  No
9.  Most unlikely
10.  No
11. No
12. Whether ofloxacin or azithromycin would work on M. genitalium is unclear.  This therapy would cure chancroid.

This thread is over.  Please do not return to this site.  EWH
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