[Question #3378] Dr. HH - Viral, HPV, HSV and Thoughts?
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90 months ago
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6 months ago a dancer at a club rubbed my penis, by the meatus. When I removed her hand, I felt a pain below the meatus opening. She also rubbed her breasts in my face/mouth area. No intercourse.I have been ill since. It started with pain and stinging in my urethra/meatus (underside). I have a red rash/inflammation on my glans that comes and goes in intensity. It is more prevalent around urination and a hot shower. It can be dry, sporadic or looks like a line from the corona to the meatus. It is uncomfortable when the region touches my boxers. I have post-void dribble and the glans swells, near the meatus. Press on swelling and urine discharges. The meatus gapes on the bottom when blood flows or erect. I believe this is from swelling/increased blood flow. I noticed purple in urethra with small bump, vein related. Thrush/dry mouth (white tongue) symptoms, loss of weight, cough due to a lump in my throat, which has subsided. PCP suggested viral cough. Maybe anxiety. At 5 mos. tested for HIV 1/2, HSV-2, Chlamydia, Gonorrhea, Hep A,B,C, Trich, & Syphilis. All Negative. Was Neg for myco/ureaplasma via urine. No intercourse so assumed would be negative. I am positive for HSV-1 and broke out w/ rash on nose after (but believe I was). Urine and semen cultures showed no bacterial pathogens. I have seen 3 urologists (one referred me to another) and 2 dermatologists. The urologists have not given a diagnosis, but gave Nortriptlyine for nerve pain (now I feel tired). One derm thought fungal, the second seborrheic dermatitis. Corticosteriod / anti-fungal / creams did nothing. I was given a cystoscopy and nothing was found. All doctors acknowledged the issues above. Was also on Doxy for 10 days. Do these symptoms sound HPV, HSV-1, or viral related and what should I do as a next step? I asked the urologist about viral pathogens and he shrugged his shoulders.
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Edward W. Hook M.D.
90 months ago
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Welcome to the
Forum. Clients on
this site are not permitted to request who responds to their questions. All
questions regarding herpes go to Ms. Warren and Dr. Handsfield and I split all
other questions. As it happened, today I happened to pick up your
question. As an FYI, having worked closely for more than 35 years, Dr.
Handsfield and I never disagree on the content of our replies although our
verbal styles vary. I will be addressing this question.
From the sounds of things, at the time of your encounter with the dancer who rubbed your penis there was some trauma and resulting irritation. This sort of trauma typically heals in a few days. There are no STIs which are transmitted through contact of a person's hands with another persons genitals. Similarly, having a woman rub her breasts on your hands and face is a no risk event for all STIs. Your thorough testing for STIs proves that your current symptoms are not due to any STI. Nothing you describe suggests any viral STI- HSV, HPV, or otherwise. Rather, my suspicion is that you are anxious as a result of the interaction and this has caused you to be excessively aware of sensations and normal variability in the appearance of your penis and genital tract. This is not uncommon when persons worry about sexual contact with a partner who may have been risky. My advice is to do your best not to worry about this, do not focus on these sensations, do not repeatedly closely examine your genital area and stay off of the internet. I see no need for further testing, no need for treatment of these sensations, and no reason to worry. Some of our clients benefit from discussing their sensations and concerns about them with counselors or mental health specialists.
I hop this comment is helpful. EWH
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90 months ago
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Dr. Hook, I am new and was under the assumption that the HPV questions went to Dr. Hansfield. I apologize as I know you have extensive experience. I do not disagree that I have been well tested. Most of the STIs below were tested in a panel test and I was not concerned given there was no intercourse. With respect to the dancer, I am confident that she rubbed her vagina, prior to sliding her hand into pants. I am not sure if this would change your answer.
To your point about trauma, perhaps this may be accurate; however, my penis has not healed for 6 months. There may be another urological issue that has not been ruled out. The challenge in my situation is that the area with pain is difficult to view on a retrograde urethrogram (which could cause more problems). I digress...
I will respectfully disagree when you note that perhaps my symptoms may be a result of anxiety. Perhaps some initially, but doctors who have observed my situation agreed that it is out of tolerance. Frankly, it is why I was scoped twice. I decided to post here because I assumed that you likely have more expertise on viral infections and associated symptoms in the genital region. Perhaps, there was a chance that some of my symptoms could align to non-wart HPV strains, especially with the changing skin coloration/urethra irritation/inflammation in the glans region. It is one of the few STIs passed by skin to skin contact.
Follow-up: I read a clinical study that illustrates penile brushing / urethral swab is statistically a good way to detect HPV strains in men. Are you aware of an "off label" kit such as a cervical swab-kit that can be used for men as a diagnostic tool? I did see a brush kit offered on an STI testing website (I won't name it here as I don't want to advertise) and I was curious about the sensitivity of this test in detecting high-risk strains. Candidly, I was thinking about a biopsy of the glans.
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Edward W. Hook M.D.
90 months ago
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Thanks for your follow-up comments. I will work through them one-by-one.
That the dancer rubbed her vagina before rubbing your penis does not change things. This was still a no risk event. Many of our clients worry about this but the fact is that secretions transferred indirectly from one person's genitals to the hands and then on to another persons genitals virtually never result in infection. This activity, which falls under the general category of mutual masturbation is a no risk activity for all STIs.
Thanks for the clarification about your persisting pain. While i do not have an explanation, I can assure you that this does not correspond with any STI. It may well be a urological problem of some sort but it is not an STI.
I did not mean to diminish the importance of your pain. OTOH, we regularly see clients with real pain which is augmented by the attention they focus on it. This does not mean that you do not have real discomfort.
With respect to viral infections, your symptoms are not consistent with described viral STIs. HPV, while widespread, is typically asymptomatic.
As you point out, testing for HPV in men is not currently approved by the manufacturers or the FDA but the brushing technique you mention is widely used in research and appears to be quite sensitive, obviating the need for biopsy. I would not however recommend HPV testing in your search for the cause of your discomfort. There is a good chance you have HPV (the majority of sexually active men do) but that does not mean that it is the cause of your discomfort. If an HPV test were positive it would likely be a case of true-true but unrelated. All too often in other patients (primarily women) I have seen this lead to efforts to cure something that is not causing the symptoms but which leads to adverse effects due to the treatment.
I am sorry for your continuing pain. I hope my comments are helpful. To me this sounds like a non-STI urological problem which needs to be addressed through ongoing interactions with a urologist whom you trust and feel you can communicate with. EWH
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90 months ago
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I appreciate the clarity and I hopefully I can figure my situation out. I am also intrigued by your HPV response. You made it clear that it is highly unlikely that my conditions are caused by HPV; however, my natural first thought is that perhaps my situation is different (I'm sure you hear this from everyone). So while you have noted that it is highly possible that I may have an HPV strain, I have inferred that there is little that I can do but wait for the infection to "clear" and I would be focused on the wrong issue anyway. My second thought is that I would like to know my status as a high-risk strain could lead to dysplasia/cancer in a future partner.
Last Follow-up: In the absence of visible lesions on the penis (warts or blisters), from your experience, which STI's would commonly cause inflammation/rashes & stinging sensations on the top of the penis glans (and/or swelling of the glans region)? I am not insisting that I have one BTW and I will take your advice to continue to work with one of the more well-known urologists in my area.
As a side note, I cannot tell you how fortunate we all are that you, Dr. H, and Ms. Warren make your expertise available. You may never know how big of an impact you are making in peoples lives, but I can assure you that it is significant. Some of the people on this forum (and on the prior one) are in desperate need of your counsel, as they are dealing with some of the most difficult issues in their life (you can feel the anxiety when you read their posts).
Thank you.
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Edward W. Hook M.D.
90 months ago
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Your interpretation of my earlier comments is correct. As an adult male in North America, there is at least a 50% probability that you have been infected by a "high risk" HPV type (high risk is a misnomer since less than 1% of persons with "high risk" HPV go on to have cancer). While some types of HPV may cause visible lesions, there are not other symptoms (i.e. pain, itching, other sensations) which occur with HPV. I would add that while your concern for future partners is laudable, it may be misplaced since if they are sexually active adults, odds are that they already have HPV as well.
As for your follow-up question, discomfort related to STIs is related to inflammation. The presence of inflammatory cells which are reacting to the presence of micro-organisms. Not all microbes however lead to inflammation and the amount of inflammation they tend to cause vary. Bacteria like gonorrhea cause a substantial amount of inflammation while viral infections due to HPV cause virtually no irritation. In addition, any sort of disruption of the surface of skin due to other causes (scrapes, dermatological problems, etc.) can cause irritation/discomfort/ and pain as well. The skin of the glans penis is particularly highly innervated and thus sensitive. Further, I should add that there is a very long list of dermatological processes that can effect the genital tract, including the glans penis. In fact, as Dr. Handsfield has pointed out, less than 1 in 4 genital dermatologic processes described in textbooks are due to STIs.
Finally, thanks for your thanks. We do our best to help our clients. Thanks such as yours serve to re-inforce that the time and effort we put into the site. As you know, with this 3rd reply, this thread will be closed later today. Take care. EWH
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