[Question #3892] Penis glans rash after oral sex 8 weeks ago
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86 months ago
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Hello Doctors,
I posted in the pasted about unprotected oral sex that lasted roughly 2-4 seconds along with intermitted hand jobs during a VIP dance at a strip club. This occurred now 8 weeks ago. I have had irritated to the glans of my penis since this exposure. The irritation is macular and well demarcated that encircles the urethral meatus and extends down to the corona on the dorsal aspect but doesn't involve the sides of the glans. This redness fades and flares up especially after showering and masterbation but seems to always be present. I have also noticed inside erythema there is circler blemishes of increased redness which looks like the folds of the glans but inflamed. The glans is painful but increases in pain with it appears more inflamed. I have been tested for gonorrhea and chlamydia both negative. I have been treated with 250mg IM rocephin, 1g azithromycin, and 10 days of 100mg twice a day doxycycline by a urgent care doctor. I have been using lotrisone topical that seems to help but does not get rid of the redness. I had sex with my girlfriend 6 weeks after the exposure and this was 4 weeks after getting the Rocephin and Azithromycin and I had 1 day left of the doxycycline. Im concerned since the rash on the glans isn't going away I could have passed a STD on to my girlfriend.
My questions are-
1. Does this rash sound like herpes or syphilis and would herpes or syphilis rash last this long after the exposure (8 weeks) ?
2. Should I be tested for Herpes through blood testing ?
3. Would this treatment regiment treat syphilis, and if so was it safe to have sex with my girlfriend at that time ?
4. Should I be tested for Syphilis ?
5.And if I were to get tested would the antibiotics I took make the testing not reliable ?
Thank you doctors !
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Edward W. Hook M.D.
86 months ago
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Welcome back to the Forum. I remember our prior interactions and am sorry you continue to worry about STIs from the events you described when there is really no reason to do so. Nothing you have described (and your description is quite detailed and precise) raises and concern about STIs and your apparent non response to ceftriaxone, azithromycin and doxycycline provide further proof that this is not a bacterial STI. This is most likely a dermatological problem of which there are many and which, I suspect, has combined with your anxiety regarding your exposure to the exotic dancers is contributing to your concerns. My advice is to see a dermatologist for this and to stop worrying about an STI.
In answer to your specific questions:
1. Does this rash sound like herpes or syphilis and would herpes or syphilis rash last this long after the exposure (8 weeks) ?
No, not in the least. further all 3 of the medications you have received are active against syphilis. This is not syphilis of herpes.
2. Should I be tested for Herpes through blood testing ?
No. A herpes blood test, if positive would not mean that your lesion is HSV and these tests have relatively frequent false positive results.
3. Would this treatment regiment treat syphilis, and if so was it safe to have sex with my girlfriend at that time ?
Yes, syphilis would have been fully treated. Nothing about the situation you have described suggests any need to abstain from unprotected sex with your GF.
4. Should I be tested for Syphilis ?
Not with regard to this problem. I am confident this is not syphilis.
Hope this helps. EWH
5.And if I were to get tested would the antibiotics I took make the testing not reliable ?
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85 months ago
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Hello Dr. Hook thank you for the continued advise. I just wanted to see your opinion on my updated status. I was recently seen by my physician who examined the area. She too felt it was not STI related and appears irritation related. Especially redness/pain increases after showering. She did however perform blood testing for HSV1/HSV2 IgG and IgM along with a RPR. I was found positive for HSV 1 IgG and IgM. The RPR has not returned yet. My physician felt no need to treat with valtrex and felt my symptoms are not related. I did stop the lotrisone and only use Johnson baby powder and I feel the redness appears less. My questions are
1. Would herpes symptoms continue for 9 weeks ? Does this seem to long for a outbreak?
2. Should I get valtrex ?
3. What does the antibody findings mean ? And does this mean the pain and erythema is now more likely herpes in your opinion?
4. How long do I need to have the infection to turn IgM to IgG?
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Edward W. Hook M.D.
85 months ago
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Thanks for your follow-up questions. The results indicate why I recommended against testing for HSV. Specifically, IgM testing is NOT recommended by any aithoratative group of experts. These tests are very frequently falsely positive and is leading. Further, most HSV-1 infections in adults do not represent recent infections but rather longstanding infections most often acquired in childhood. This the case even in persons who do not experience cold sores. I agree with your physician that herpes treatment is not needed and will be of little benefit. In answer to your specific questions:
1. As I already mentioned, your symptoms are not suggestive of genital HSV. Further these symptoms have continued far longer than would be expected for HSV.
2. No, see above.
3. My opinion has not changed. This is almost certainly NOT herpes. It is a Dermatologic problem unrelated to the sexual exposure you are worried about.
4. I urge you to ignore the IgM test. It may or may not change. It is of no value
EWH
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