[Question #5385] Troublesome

21 months ago
Hello Doctors,
I'm a male who had one time unprotected oral and vaginal sex with a female on 4/3/19. Female did state that she had no STI's/STD's.  One week later on 4/10/19 had testing for Chlamydia and Gonorrhea; NEGATIVE.  Fourteen days post encounter on 4/17/19 had HIV/RNA test; NEGATIVE.  One month post encounter on 5/1/19  had full STD panel testing: HSV 1/2, HIV 1/2 4th Gen, Syphilis, HEP A/B/C, Chlamydia, Gonnorrhea; ALL NEGATIVE.  6 weeks post encounter on 5/15/19 had another full STD panel of testing; ALL NEGATIVE.  During this entire process I have had no lesions, redness, or bumps of any kind. Also, I will let you know that this was my first encounter since testing negative for ALL STD's back in October 2018. That testing include a University of Washington Western Blot test which was negative for both HSV 1 & 2. So I most definitely know that I was free from any STI's/STD's prior to this latest encounter.  Here is my problem/question. Last night I noticed 3 small slightly raised red bumps on my penis head. They are not in a cluster but spread out a bit. They are COMPLETELY PAINLESS.  In fact I put Hydrocortisone on them last night, and they seem to be a bit better; not entirely sure. What, if anything should I be worried about here? I had completely moved on; and BAM, now this.  Completely painless makes me worried about syphilis, but I was negative at 4 and 6 weeks. Red bumps makes me worried about HSV, but I had a negative Western Blot in October, and two negatives at 4 and 6 weeks post this recent encounter.  This would be too far out to be a primary outbreak I would think? No fever, or any other symtoms. Thanks in advance for any advise and input!
Edward W. Hook M.D.
Edward W. Hook M.D.
21 months ago
Welcome to our Forum and thanks for your detailed description of your exposure and testing.  The exposure you described was very low risk and the test results you describe effectively rule out all of the STIs you describe.  The average time for appearance of a primary syphilis lesion is three weeks and the average time for appearance of new HSV lesions is around 10 days following exposure.  OTOH, it is be little early for a genital wart to appear and HPV would not appear overnight.  Thus I would not be worried about STIs acquired at the exposure that you have described.  Far more likely is one of the many, many dermatological problems such as a fungal infection.  My advice would be not tot worry about these lesions and observe them- if they were an STI they would evolve with HSV lesions becoming vesicle or small open course within a day or two and syphilis becoming ulcerative over the next few days.  Other problems such as a fungal infection would not change much.

The other question I should ask however is whether you are examining yourself more closely that you did before your exposure of concern and whether or not these spots may have been present previously but not noticed.  Further, repeated vigorous self-examination can also lead to irritation and lesions.

I hope these comments are helpful.  I would not be worried that the spots you describe are an STI acquired at the encounter you describe above.  EWH
---
21 months ago
Good Morning Dr. Hook, Thank you for your prompt response and expert advice. I'm simply giving an update to my situation as I believe it helps you build data, and possibly gives others who read this forum answers to their own situations and concerns. First, the three red "dots/bumps", which were about the head of a pin in size; definitely are something new and not just something that I discovered due to closer examination. However, the good news is that they have improved greatly after a little more than two days. I've simply used 1% Hydrocortisone twice daily since Saturday evening and they are now only slightly visible. If I'm correct, this rules out most, if not all STD's/STI's from my encounter 7 weeks ago correct? The "Spots" were never at all painful, fluid filled, never ulcered, and never crusted over. If they continue to improve at the current rate, I believe they will have come and gone in a matter of 3 or 4 days. I'd appreciate any other advise and/or opinion regarding this matter. Otherwise, take care and Thank You!    PS: Please leave this thread open for a final follow up or question just in case. THX
Edward W. Hook M.D.
Edward W. Hook M.D.
21 months ago
Thanks for the additional information.  You are correct, hearing additional detail and about the evolution of changes is very helpful.  The fact that hydrocortisone may have helped this resolve makes STIs all the more unlikely as topical hydrocortisone, if anything, would have made STI-related rashes worse.  Similarly, STI related rash would not be gone so quickly.  In my opinion, there is virtually no risk that they are an STI.  

This thread will remain open for another 30 days in case there is  another f/u question.  Take care.  EWH
---