[Question #3575] STD worries

36 months ago
Hello Dr.

About 5 weeks ago I had an encounter with CSW.  This was a protected encounter.  I tested for all STDs at 4 weeks including 4th gen HIV test.  After a 2-3 days I noticed 2 tiny bumps in my penis shaft foreskin.  One of them had a scab already and cleared up in the following 4 days. The other was a tiny bump very superficial with no redness around it.   It’s been 5 weeks and the bump is still there.  I did notice some red spots in my buttocks but I’ve usually always had these, my heightened awareness made me notice them more.  The tiny bump Hasn’t really changed in size or developed into a sore. What can this be? Can this be herpes or syphilis. I tested negative at 4 weeks.   I don’t have any symptoms really other than my anxiety is driving me nuts and I do have frequent urination, no pain or anything. I think that’s Bc of my anxiety.  Can you please give me your opinion? 
1- Can this be syphilis since blood test are not accurate up until 6 weeks? 
2- can it be herpes, but the existing bump is 
Still there and this is not common from what I have read. 
4- are my 4 week test conclusive for everything else? 
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
36 months ago
Welcome to the forum. Thanks for your question.

This sounds like an entirely safe encounter. (Congratulations for having safe sex!) I'm not entirely sure what to make of the things you're seeing on your penile skin, but they aren't typical (or even suggestive) of syphilis, herpes, or any other STD. While syphilis can cause a diffuse skin rash that could involve the penis (and often does), this is not what that rash looks like; occurs only in the secondary stage of syphilis, no earlier than 2-3 months after infection; and always with a positive blood test. The initial lesion of syphilis, the called chancre, appears as an obvious open sore, larger than what you have described. (You can google syphilis images and photos for examples of typical chancres and rashes of secondary syphilis. You'll see they don't look anything like what you have. You can do the same with genital herpes; you'll also see nothing like you have described for your penis.) As for frequent urination, I agree that's a typical symptom of genitally-focused anxiety. To your specific questions:

1) For sure not syphilis, as discussed above.

2) Ditto for herpes. You are correct that a single lesion persisting unchanged this long would never be herpes.

4) (3 is missing):  The 4th gen HIV test at 4 weeks is nearly conclusive, 98-99% reliable. You could have another test at 6+ weeks if you like, but it really isn't necessary. There is no realistic chance of HIV from this exposure or as an explanation of your symptoms. You don't say what other tests were done, except you allude to syphils (correct about syphils blood test not being conclusive until 6 weeks). If a urine gonorrhea/chlamydia test was done, it was conclusive. Other blood tests require more time, 6 weeks for viral hepatitis and 3-4 months for herpes. But I'm not recommending any further testing at all. There is simply no realstic chance of any of these.

So what's causing the penile skin issues? Perhaps a little chemical irritation of some sort; minor dermatitits (the large majority of genital skin problems are not STDs); or, perhaps mostly, your anxiety leading to closer self-examination and perceptions of change or abnormality, when in fact you're just seeing normal variations in skin appearance. But if you are not convinced and/or want further reassurance, see a dermatologist. But in the meantime, I don't think you need to worry about any STD or any other infection from the sexual encounter af ew weeks ago.

I hope this information is helpful. Let me know if anything isn't clear.

36 months ago
Dr. Handsfield

Thank you for your very fast response.

Never developed a rash of any sort.

Just to clarify I did all test except herpes Bc I know that even I I had it at this point it would be too soon to come up.  

In regards to the herpes which is originally my biggest concern.  The first bump I couldn’t really tell what it was at first Bc I noticed it maybe 2 -3 days after and it Already had a scab. It was completely healed at 5-7 days.  the other small  bump/blister/pimple whatever it might be was noticed Bc I inspected my shaft heavily and realized it was there.  Yet this has persisted and is still there 5 weeks later . Doesn’t hurt , not an open sore , basically no symptoms other than the symptoms I give myself for thinking about this.  Anyhow my encounter was fully protected and I’m almost 100% sure that the location were the lesions showed up were covered by the Condom.  Does that make a difference? And also to clarify they were not close to each other. 

I’ve read online that herpes is very common and many people have it without knowing , it makes me feel better to read some of the post you have in regard to herpes transmission which really puts my risk to be very low . It’s just the lessions that have my mind going.  

36 months ago
I will use this as my second follow up included to clarify on my test.

5 days after exposure I 
36 months ago
Sorry I submitted by mistake.  This is my second follow up continued. 

Testing done

4.5 -5  days after my exposure I tested for HIV,  clamedya/ gono  and Syphilis. Understanding that it was too soon for results for hiv and Syphilis. All came back negative.

At day 22 - I retested 4th gen test for HIV . Negative 

Shortly after the test I started antibiotic treatment for H pilori. Ongoing condition that I’ve had. It included amoxicillin, chlarytromicin and pantropazole. 

At week 4 (day 30 ) - retested for HIV 4th gen to confirm   , chlamedya/ gono and syphilis. From my understanding the antibiotics might have skewed the results of the chlamedya/Gono. 
My questions are the following 
1- if my 4 week test of  chlamedya/ Gono could’ve indeed been skewed will my original 5 day test  be conclusive for that. 
2- Can these antibiotics affect my HIV result? 

Thank you very much for your answer. This along with your initial answer will finally put me at ease. 
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
36 months ago
This doesn' sound like herpes. Among other things, any herpes lesions/outbreak would be red and inflamed, and would not develop a dry scab in only a day or two. This doesn't sound at all like herpes.

The H pylori antibiotics would not have altered your gonorrhea/chlamydia test results, assuming you hadn't been taking the antibiotics more than a couple of days when tested. Amoxicillin and/or clarithromycin would cure syphilis, perhaps preventing the blood test from ever becoming positive -- in the slim chance an infection were incubating. But tat's extremely unlikely.

1) There is no point in having any further tests for gonorrhea/chlamydia. You already know for sure you weren't infected. In any case, if somehow you had them anyway, the H pylori antibiotics would clear either infection -- and the test would never be positive. For sure no point in being retested for them.  It's OK to be retested for syphilis, but you can expect continued negative results.

2) No medications have any effect on HIV test results. Certainly these antibiotics won't interfere.
36 months ago
Thank you for your reply. 

Have a great day