[Question #2279] penis infection

48 months ago
I am a 44 year old circumcised male .. I have been traveling in SE asia for about 3 years and dating girls when in Thailand and Philippines. Three years ago I had sex with a girl with a condom.  After sex I noticed some white goo from her on my pubes as I took the condom off (yeast I assume now).  I wiped but did not wash right away.  Within a week I developed a penis rash but did not treat immediately and it developed into a bad fungal infection of my penis shaft  and groin area all over (inner thigh/ scrotum red / etc).  The penis shaft skin dried and cracked before It cleared up after treating diligently for a several weeks with canestan.  I had penis sensitivity for several months after that.  I had no risk factors for HIV at that time (all protected sex).  Since then I have had a few unprotected encounters with girls (past 2 years) (no sex workers, girls dated from online .. but from those countries (Thailand and Philippines).  3 months ago after having unprotected vaginal exposure during sex with a new girl I noticed my penis was a little itchy the following week.  I did see a faint reddish area in the groin and belly button where it also itched ..  because of my prior experience I applied canestan cream and it cleared within a week.  Lastly I took some antibiotics about a month ago and after completing their course I noticed irritation at the tip of the penis and penis head sensitivity .. walking my penis would rub the inside of my pants and I could feel it get irritated.  so I am applying canestan cream again.  I do not have any other symptoms and otherwise feel healthy.  My question is .. are these symptoms / penile thrush consistent with early/mid HIV?  Reading online makes it sound like Diabetes and HIV are the only likely causes of penile thrush.  Very concerned
Edward W. Hook M.D.
Edward W. Hook M.D.
48 months ago
Welcome to the Forum.  I'll be glad to comment.  There are several elements to your question, one being are you at risk for HIV, the 2nd being if not, then what is going on with your penile fungal infection.  I will try to address both.

First, HIV risk.  Over the past two years you have apparently had multiple sex partners, met on-line, with whom you have had unprotected intercourse.  If I'm correct on this, then I advise you to get checked for STIs, including HIV (your risk for HIV is far low than your risk for chlamydia or other STIs).  By that I mean a urine test for gonorrhea and chlamydia and blood tests for HIV.   Overall, I suspect that your risk for any STI is rather low but each of these infections can occur asymptomatically and each is treatable.  If you continue to have occasional unprotected casual sexual encounters, I would also suggest that you plan for regular, annual checkups as part of your regular sexual health practices. 

Now, for your questions about genital fungal infections.  Most yeast infections in men is not associated with either HIV or diabetes.  Factors which increase the risk include taking antibiotics, as you did before your most recent episode, as well as just being in areas where your genitals tend to be moist.  Many genital fungal infections do not have an obvious cause.  My advice is to use the cantesan cream as you are doing, keep your genitals clean and dry and not worry.

I would add, that after an infection of the sort you have, it is not uncommon for infected skin to be a bit more sensitive than it was in the past.  I suspect this accounts for the sensitivity you report.

I hope these comments are helpful.  As for forum Guidelines, if there are further questions, we can certainly address them in your two follow-up questions.  EWH
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48 months ago
http://www.poz.com/pdfs/P04-14p53.risk_transmission.pdf
https://www.poz.com/article/HIV-risk-25382-5829

Doctor I am wondering what my chance of HIV exposure and risk if exposed was.  If you check the two links above they indicate much higher risk for a single exposure in low income countries (I was in Philippines / Thailand).  It is alarmingly higher:  they cite male chance of infection from penile/vaginal at 1 in 263 vs the 1 in 2,500 here in the USA.  How can those numbers be so vastly different?  They also indicate a woman's chance as less than a man's at 1 in 333 .. which seems odd giving what I have read before.  In your opinion is this chart accurate?  .. I am trying to determine what my chance of having been exposed per 1 encounter would be?  and if exposed what my chance of getting infected would have been?    Lastly it has been about 2 months since my last exposure (condom came off during sex) .. is it late enough to get an accurate test and could I get a urine or oral test instead of a blood test?  Thank you
Edward W. Hook M.D.
Edward W. Hook M.D.
48 months ago
You may not be reading this article carefully enough.  The chart's replies do accurately reflect current thinking about risk if one is exposed to an infected sex partner.  For instance, the difference you point out between "high" and "low" income countries rates to the background rates of HIV in those nations.  The rates of infection in high income countries are about 10 times higher than in low income countries.   Similarly, the chart indicates that a woman is more likely to acquire HIV form an infected man than a man is to acquire infection following sex with an infected woman.  this is consistent with what we have said on this site in the past. 

Your risk following the exposure you describe is calculated by multiplying your risk from receiving oral sex (1 in 2500) times the likelihood that your partner had untreated HIV.

After 4 weeks a blood test for HIV using a combination HIV antigen/antibody test will provide you with accurate results.  I would suggest the blood test.  EWH
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48 months ago
Sorry doctor, but i was confused by multiple things in your response ....

"The rates of infection in high income countries are about 10 times higher than in low income countries." .. did you mean to say the opposite (infection rates are higher in low income countries?)

 "Similarly, the chart indicates that a woman is more likely to acquire HIV from an infected man than a man is to acquire infection following sex with an infected woman.  this is consistent with what we have said on this site in the past. " .. the chart does not say that in Low income countries (where I was)

"Your risk following the exposure you describe is calculated by multiplying your risk from receiving oral sex (1 in 2500) times the likelihood that your partner had untreated HIV." .. why multiply by oral sex risk if I indicated I had vaginal sex? ..

Perhaps the link was not correct:    http://www.poz.com/pdfs/P04-14p53.risk_transmission.pdf


Edward W. Hook M.D.
Edward W. Hook M.D.
48 months ago
I apologize, I have been working with several clients at the same time and made both typos and misread your post. 

Sorry for the typo. Yes rates are higher in low income countries when compared to high income countries.  Please realize that this is a generalization.

You are right.  I was focused on high income countries.  As an estimate, the rates are quite similar for female to male and male to female genital-genital exposures.  Your genital exposure was condom protected, thus virtually no risk as long as you use d the condom correctly and throughout your encounter.

Again, my apology.  If your only exposure was unprotected vaginal sex.  Thus, your risk, IF your partner had untreated HIV (was about 1 in 300).  You do not know her status however. 

These were my typos, therefore I will not count these replies and you may ask one more follow-up question if you wish.  EWH 
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47 months ago
Thanks for the clarification.  Lastly .. I recall about 2 weeks after an exposure I was hiking a lot and sweating (bit hot and humid) in the Philippines and developed a chest rash that cleared up over night.  A week later in Malaysia (also hot and humid) I got a much larger rash that was on my chest abdomen and groin area.  This would be about 3 weeks post vaginal exposure .. I have never gotten this rash before and I have read body rash can be a symptom of ARS.  I have read here though that the rash generally does not show up without other symptoms.  I do not recall any other symptoms .. though since I was in hot weather already is it possible I could have not noticed a fever or missed other symptoms?  Are the symptoms that accompany an ARS rash such as high fever easy to miss or very noticable?
Edward W. Hook M.D.
Edward W. Hook M.D.
47 months ago
The symptoms of the typical ARS are quite prominent and include noticeable muscle aches, sore throat and high fever, making it unlikely you would have missed other symptoms.  From what you say, this rash does not sound like part of the typical ARS syndrome.   As I mentioned earlier, you are now at a point at which an HIV test can completely resolve your concerns.  If your symptoms were ARS the test would not be positive and testing with the currently used preferred test, a combination HIV antigen/antibody test would help to rule HIV out.

As you know, threads are closed administratively after three responses.  This thread will be closed later today.  Take care.  EWH
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