[Question #7390] Unknown STI/Genital Issues

6 months ago
Hi

I received unprotected oral sex in March and have had various issues with my penis and anus since.

I am male and based in the UK.

I have visited many health care professionals in the UK and they cannot give me an answer.

Almost immediately after the encounter I have had a need to pee more, looser stools, change to my penis glans which comes and goes and changes daily, there is often a red blotch on my meatus. When erect  the glans become very red and often bumpy and hurts after the glans are wrinkled, red and dry. None of this happened before.

I had a red patchy rash in my inner groin at 7 months, no blisters but slightly sore to touch. This lasted for 6-7!weeks and still isn’t right.

I also have also had a red rash around my anus and some small red cut like marks at the top of my bum.

I have tested for, Chlamydia, gonerreha, hiv, syphlis at 4 months and all negative. I also did a private test at 3 months for all the above and more and also negative except gardernella and ureaplasma. I saw my GP about this and they said normal so don’t worry.

I self prescribed doxycycline for the above and no change. I am currently trying Aciclovir 400mg twice a day as thought it could be herpes. I am on day 5 and no improvement.
I am not sure if I am right to do this but not sure my symptoms link up to herpes.

I am desperate and trying to be responsible so I don’t pass anything on but the UK health service are not helping any more.

It has 100% occurred since this encounter and ruined my life. 

My question is do you have any thoughts what this could be and what I should do?

They do not test for HSV in the Uk without open sores, so been unable to do this. A blood test would not definitely tell me it is from this as could have caught it in the past with no symptoms. 

Could it be trauma/damage? Could I have caught an anal Sti from oral sex?




H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
6 months ago
Welcome back to the forum. Thanks for your continued confidence in our services.

I reviweed your discussion with Terri 3 months ago. I agree with her advice. And I'm afraid I really can't help much. No distant expert is liekly to ever come up with a new opinon, diagnosis or advice after someone has seen "many health care professionals... [who] cannot give me an answer."

No STD causes the sorts of symptoms you describe. That includes herpes, HIV and everything else -- and all the tests you describe are conclusive . As for any visible rash, I'll just say that I have a book titled "Genital Dermatology Atlas", 300 pages long, filled with photos of various skin problems in the genital area. All STDs are covered in 15 pages -- the point being that the vast majority of such problems are not STDs. Many of most of your symptoms sound to me like the effects of anxiety, and perhaps an emotional response to a sexual decision you may regret. I don't believe in psychological factors creating symptoms out of think air. However, they certianly can greatly magnifcy minor symptoms or even normal body sensations that otherwise would be ignored or not even noticed; and also alter the perception of what the skin looks like.

To a few specific questions/issues:  I would not recommend HSV testing, with or without genital lesions. And no, you cannot catch an anal STD by oral sex. The lack of improvement with doxycycline and acyclovir also are evidence that no bacterial STD nor herpes is present or the cause of any symptoms.

So my advice is to first, accept the reassurances you have had from "many physicians" and no on this forum. Assuming your symptoms continue and/or you remain concerned, I would advise speaking fraking with your personal physician (e.g. a GP?) or perhaps a GUM specialist. If they agree with a likely psychological factor and recommend professional counseling, follow that advice. And please don't push back on that:  I know what I'm talking about, and I suggest this from compassion, not criticism. Good luck.

HHH, MD
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6 months ago
Thank you for the reply and comments. I really do appreciate your input.

When I say ‘many health care professionals’ I mean 2 x local GP’s and 2 x Gum clinic doctors. The issue is I haven’t been able to show them any real symptoms as they say it looks normal. But things have changed and how it feels down there is often irritated and itchy. With no physical symptoms the GP’s suggested fungal cream which I tried to no joy and they left me at that. The doctors at the Gum clinic just went through the motions and tested the 4 they do in the UK hiv, syphlis, chlamydia and gonerreha. All negative at 4 months. After that again as no physical symptoms they have not helped any further.

My main issue is my glans when erect, they look bumpy, inflamed and like more prominent veins underneath, how it feels when erect is also an issue like it is more puffed up and just uncomfortable. So even if I did accept there was no sti I can’t carry on with my normal life. This all stemmed from that night hence why I am pushing some type of Sti. 

I take on board your comments regarding this being in my head but I really don’t see that being the case. I regret the incident so much but all of these symptoms are not exaggerated in my head.

Can I ask why you would not recommend HSV testing with or without symptoms?

Any input on the glans would also be appreciated.

Also could this be a type of HPV? The bumps on my glans when erect?

Mgen and trich worth considering?

I need a doctor to see my penis when erect, but this is frowned upon and I guess what got me in to this predicament. 

There are many forums on patient info with many similar men with this problem with no answer.

Honestly I value your input more than anything. I just want to be back to how I was.

Thanks






H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
6 months ago
Thanks for the thanks and your kind words about my input so far.

I consider 4 doctors, including two GPs and two GUM specialists, to be "many". And if they all say your penile skin, anal area, other places they have examined look normal, then I have every confidence they indeed are normal -- regardless of how different than previously they appear to you. I have no particular comment about the appearance of the skin of your glans penis or anywhere else:  since your doctors say it's normal, that is also my belief. Your description sounds normal to me too, and I am confident any difference in appearance between flaccid and erect is unimportant and also normal.

In my 45 years in the STD business, giving advice to hundreds of people in situations like yours -- that your symptoms have a psychological origin (or magnification by emotional factors) -- the large majority deny the possibility. However, I was wrong in none of those patients, to my knowledge. You're the one using the term "in my head", which I carefully never use myself. That implies the symptoms are not real, but they are. Just as tension headaches are real and painful, but with a physiological explanation -- i.e. psycholoogical issues causing increased tension in neck and scalp muscles.

M genitalium and trichomonas? No way. They are not carried in the mouth or throat, therefore not transmitted by oral sex; and none of your symptoms fits with either one. And HPV doesn't behave like you describe either. Of course you can assume you have had and may still have a genital HPV infection. 90% of all people are infected at one time or another, and at any point in time in people age 20-50, around half have detectable HPV DNA of the genital or anal area. But certainly HPV isn't causing any of the symptoms you describe.

As for many forums with many men with similar problems, that's to be expected. People with symptoms that concern them and are unexplained obviously are selectively drawn to certain websites. It doesn't matter how many of them are convinced they some sort of mysterious undiagnosed infection, that fact does not influence my opinions or advice to you. 

So now you have received reasoned, science based evaluations and advice from 5 physicians, at least 3 of us being experts in this area. Continued searching online or looking for additional expert opinions, or additional testing of any kind, aren't going to get you anywhere. What are you going to do about it? 
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5 months ago
The main visible symptoms are only showing when erect, so difficult for anyone to review. This is physiological opposed to psychological. 

Whether it is trauma related or damaged I am unsure.

Can I ask does the meatus dip slightly at the top of the penis?

I will continue the search as this has completely changed by life for the worse. 

The doctors I have seen have more done a tick box exercise. So done the basic tests and all negative so no further investigation. When I talk about my glans they are dismissive. I accept that when flaccid it looks okay the majority of the time, but it’s the erect issue that is uncomfortable and more obvious. 

Well thanks for your comments.



H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
5 months ago
Oh come on. If nothing can be seen when flaccid, anything you see when erect is unimportant and probably normal. Further, the very fact that something this trivial "has completely changed by life for the worse" is powerful evidence of a psychological/emotional issue. Also, penile anatomy gradually changes with age -- just as skin anywhere does. If you're say in your twenties, you might just be viewing natural variation with time. In any case, it is patently obvious you have nothing that will ever harm you or a sex partner and there is no possibility it is an infection or any other problem acquired during the oral sex event. In any case, why can't you take a close-up photo of yourself when erect and show it to a dermatologist? If you do, I'm confident s/he would confirm nothing abnormal is present.

Accept my expert, science-based judgment and advice or not, I don't care -- but this isn't a debate and I'll have nothing more to say.

That completes the two follow-up exchanges included with each question and so ends this thread. Good luck.
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