[Question #4471] Skin Rash - Perhaps Balanitis too. Need assitance.

30 months ago
Dear Doctors,

I'm a 38 y/o circumcised male. Had protected vaginal sex with and received fellatio from a CSW 19 weeks ago.
- 4-5 days after exposure, had a burning sensation in urethra. Doctor put me on doxy, didnt help. After maybe 3 weeks, it went away on its own. No discharge.
- About 1 week later, had a flu like illness.
- 1 week to 8 weeks post exposure, had ulcers in mouth, some itchy rashes on body that disappeared after a day or so and a few other minor issues that got me worried.

I am mainly worried about the following: 

- Around 10, maybe 11 weeks, I noticed a skin rash on the side of my torso, on both sides. Like very small pimples some red, some skin color. They start above the waist and go all the way up to the armpit (not inside the armpit) and shoulders and arms (only above the elbow). I now have hundreds of them and its been 5-6 weeks since I noticed them. No itchiness/irritation. Recently they started showing on my forehead.
- Around 11 weeks, noticed that parts of the head of my penis are lighter than the rest. A pinkish color. Since I noticed them, they haven't gotten any better or worse (Maybe I have always had them)
- Around 11 weeks, noticed some small red dots on the head of the penis, and some right under the head. In 5 weeks, I have definitely gotten more of them and some got a bit bigger. No itchiness/irritation/discharge. Maybe once or twice i had a burning feeling after ejaculation. They do look like balanitis.

My specific questions:

1 - Up to 16 weeks of negative AB/AG tests, I can definitely rule out HIV, right? (no Pep or Prep).
2 - Do these symptoms raise concern about any particular STD? Could the skin rash and the red dots on the penis be related?
3 - Have I put my regular partner at risk by having unprotected sex with her? If this is balanitis, can I give it to my partner? (She is STD free 100%)
4 - I will see a doctor this week, but I am not sure if I should see a dermatologist or a urologist. Can you advice?

Much obliged for your assistance.
Edward W. Hook M.D.
Edward W. Hook M.D.
30 months ago
Welcome to the Forum.  I'll be glad to try to help.  The exposure you describe was relatively low risk- most CSWs do not have STIs and even if your partner did, condoms are the most effective means of presenting acquisition of an STI if exposed and among sex acts, the risk from receipt of unprotected fellatio is low for all STIs and zero for HIV.  Although conservative sources such as the CDC estimate that the risk for HIV acquisition from receipt of fellatio is less than 1 in 10,000, I know of no proven cases in which a person acquired HIV from receipt of oral sex- you are not going to be the first.

The skin rash that you describe is not typical of any STI.  Parts of your description sound like molluscum contagiosum- sometimes and STI but more commonly a childhood infection but the location and extent is unusual.  My advice would be to see a dermatologist for a diagnosis.

Finally, the red dots you describe could well be a fungal balanitis.  Again, not typically an STI but instead an overgrowth of a fungus (usually Candida) which can happen to anyone, sometimes more common in persons who have taken antibiotics recently.

Thus, in response to your questions:
1 - Up to 16 weeks of negative AB/AG tests, I can definitely rule out HIV, right? (no Pep or Prep).
Absolutely.  You do not have HIV.  You do not need further testing .

2 - Do these symptoms raise concern about any particular STD? Could the skin rash and the red dots on the penis be related?
See above.  without examining you, I cannot go further.  As I said, this really does not sound like and STI.  I suggest you see a dermatologist.

3 - Have I put my regular partner at risk by having unprotected sex with her? If this is balanitis, can I give it to my partner? (She is STD free 100%)
Nothing you have said suggests any need to abstain from unprotected sex with your regular partner.  

4 - I will see a doctor this week, but I am not sure if I should see a dermatologist or a urologist. Can you advice?
Go with the dermatologist.

I hope these comments are helpful.  If there are further questions or a need for clarification, the Forum permits up to 2 follow-up questions for each thread.  EWH

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29 months ago
Dear Dr. Hook

Thank you very much for your reply. Dermarologist said it is just acne, but it did alert me since i never had them to such an extent and they showed up after oral intercourse. 'The skin rash' on the penis - as he called it - cleared after a week of anti-fungal cream. The burning sensation came back after the cream tho. Had a urine analysis, urine culture and a semen culture, all came back clean. I guess as far as STD's are concerned, I am in the clear. Urologist said i must have chronic non bacterial prostatitis- second time i have been told that. 
I have a few more questions i hope you will be able to answer -and i believe will have some educational value for anyone reading- before i end the thread and this whole chapter of 'oh god did i get something?'

1 - if one were to be infected with chylamydia, gonorrhea or syphilis, would that somehow show in the urine or semen culture? Perhaps not as a clear diagnosis but would there be 'growth' in the specimen since these diseases are all caused by bacteria?
2 - my encounter being unprotected receptive fellatio and protected vaginal intercourse, and in the absence of any symptoms that may be consistent with syphilis, do you think i should get tested for syphilis? (Apart from this one time incident, i have been in a monogamous relationship for the past 4+ years). Its been 20 weeks now since the possible exposure.


These will be the last of my questions. Once again thank you so much for this great service you are offering here. The value of this forum far exceeds its cost and in my eyes you guys are heroes for doing what you are doing.

Much respect.
Edward W. Hook M.D.
Edward W. Hook M.D.
29 months ago
I agree with your doctors.  It is time to put any concerns about STIs behind you.

With regard to your followup questions:
1.  Tests for STIs require specific teslots for the organisms you are testing for..  Syphilis would require a blood test.  If gonorrhea or Chlamydia were present, there would likely be clues such as signs of inflammation (white blood cells). Your urologist would have seen this if present.
2.  Your risk for syphilis is extraordinarily low.  There is no need to test for syphilis.

I hope these comments will allow you to move forward from your concerns.  I urge you to do so.  EWH
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