[Question #8476] Penis hurt aspect of ulcers

43 months ago

Dear doctors,

I’ve been having sex with two girls unprotected for a while.

Last time I had sex, my penis got hurt due to the friction and low lubrication.

Right after the sex when I went to shower, I noticed my penis very red and hurt (like balanites) and one special hurt next to the frenulum that opened part of the flesh.

I was sure this was not related to any STD because I just had sex and it would not appear that fast. I thought all hurts were due to the rough sex.

The point is that the hurt next to the frenulum is getting better but at other point of the penis (on the beginning of the head, where the skin fold - I’m not circumcised) 3 hurts very near each other that were not bad, rather than get better they got very worse getting the aspect of ulcers (3 to 5mm big). I also have others 5 small hurts (1 to 2mm) around the penis. No itching and no hurt (only very little burn when showering)

Due to the holidays season I couldn’t appoint with an urologist fast. Due to my desperation I self medicated (acyclovir 400mg 4x day, I took single 500mg ceftriaxone and started taking docyclyne 100mg 2x day - will do 14 days)

I also tested (3 days after notice 3 ulcers got worse) for herpes igg and igm and syphilis (vdrl and fta-abs).

I also thought that could be chancroid (H.ducreyi) but I guess there is no test for that…

My questions are:

On the overall what this seems to be or could be in your opinion?

If this is syphilis will it apear positive in the tests? (Tested 3 days after the ulcer)

If this is herpes would it appear positive in the test? The igm would appear positive already?

The medication I took (and am taking) (single shot ceftreaxone, acyclovir and doxyclyne) would cover herpes, syphilis and chancroid? Is there anymore thing I could do?

How long take for the ulcer to get better if they are caused by one of these STDs?

When ulcers heal can I resume unprotected sex? Or I have to wait more time?

If my results come back negative and my ulcers heal should I re-test latter?

I still have hope this ulcers are due to the rough sex with low lubrication, but I never got this hurts that like before and Im having sex with 2 girls unprotected, so I think there is a high probability of being something.

Many thanks and happy Christmas and new year for you and all your family!

H. Hunter Handsfield, MD

43 months ago

Welcome back to the forum. However, you're essentially asking for a diagnostic evaluation -- which we cannot do. We make no attempt to evaluate or diagnose particular clinical problems. You'll need to get medical care in person to evlauate this.

"On the overall what this seems to be or could be in your opinion?" No STD is a likely cause, largely for some of the reasons you state yourself. This is strictly an STD forum, not one for evaluating non-STD genital problems.

"If this is syphilis will it apear positive in the tests? (Tested 3 days after the ulcer)" No. Syphilis blood tests take up to 6 weeks to become positive, and never within a few days.

"If this is herpes would it appear positive in the test? The igm would appear positive already?' Up to 12 weeks for HSV blood tests to be positive. And the IgM herpes tests never are reliable; STD experts never use them -- they miss most infections and even more often are falsely positive in people without herpes. Entirely useless.

"The medication I took (and am taking) (single shot ceftreaxone, acyclovir and doxyclyne) would cover herpes, syphilis and chancroid? Is there anymore thing I could do?" Completely nonsense treatment in this situation, with no likely benefit and good chance of making future testing for all infections unreliable. Stop treatment and see a doctor, even if it takes a week or two.

"How long take for the ulcer to get better if they are caused by one of these STDs?" Probably irrelevant. I have no advice here.

"When ulcers heal can I resume unprotected sex? Or I have to wait more time?" Do not have sex until the diagnosis is clear, even if it takes a few weeks.

"If my results come back negative and my ulcers heal should I re-test latter?" All these tests will be negative. That will not mean you do not have these infections. You need in-person professional care. Unfortunately, the treatments you took probably will mean you'll never know for certain.

I agree injury during sex is the most likely cause of these problems.

I hope these replies are slightly helpful. Thanks for the nice wishes -- Happy Christmas to you as well.

HHH, MD

Rough sex with injury seems the most likely explanation

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43 months ago

Hi Dr Handsfield.

Many thanks for the really fast reply, specially during holiday.

Last questions to close this thread

When you say syphilis test takes 6 weeks to show positive, you meant from the exposure or 6 weeks after the ulcer apear?

Is it true syphilis appears an Unic ulcer? So having more than one ulcer indicates it is not likely syphilis?

By your comment that with the medication I took can make future tests unreliable, does that means If it was caused by syphilis and taking consideration all antibiotics I took early stage (before tests come positive) there is a chance it could cure and never appear positive in future tests? So I could have got syphilis for a while but will never know I got it?

Many thanks again.

43 months ago

Sore, one more:

Syphilis ulcer with the right treatment (not necessarily the one I took) takes how long to heal?

H. Hunter Handsfield, MD

43 months ago

If there are no symptoms, 6 weeks from exposure. With genital ulcer, blood testing can begin 2 weeks after onset, and if negative, repeated every 1-2 weeks until 6 weeks. However, if the ulcer is sufficiently typical for syphilis that the patient is treated before 2-3 weeks, the blood test usually never becomes positive (as you imply yourself in your last question).

Most syphilis ulcers (chancres) are single, but 2 or even 3-4 sometimes occur. The appearance of the ulcer (to expert eyes) and timing are more important than the number.

"By your comment...": Exactly right.

If I correctly understand your question, your penile lesions ("hurts") started immediately after sex. That totally rules out any infection from that exposure as the cause: no infection can start to cause symptoms within hours. And syphilis lesions never start sooner than 10 days. This is the main reason the various treatments you took were not reasonable. However, if you had other sexual contact(s) in the preceding days or weeks and acquired an STD causing genital ulceration at that time, it is conceivable that the new sexual exposure just brought the problem to attention, even though acquired earlier.

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43 months ago

Many thanks Dr.

I’m sure if a STD, it was not by the last encounter appearing only hours after sex. But as I said in the beginning I’m having regularly sex with 2 girls unprotected. So that I thought could be a coincidence that a possible STD ulcer appeared at that time.

Only one question that was missed your reply (or maybe there is no answer?): for syphilis, how long ulcers heals from the treatment?

Many thanks again and it is all for me. Im very greatfull by this excellent service, that I’m sure you don’t need it but do it by vocation and help lots of people around the world.

Best regards.

H. Hunter Handsfield, MD

43 months ago

Chancre healing would start within 2-3 days, with complete healing just like any sore once the cause is gone, i.e. 1-2 weeks, depending on how large the ulcer was to start.

With only two partners, obviously if you have an STD, one or both of them also has it. A smarter approach here would have been for all three of you to be tested, instead of you alone. If you remain concerned, they should be tested now (gonorrhea/chlamydia by vaginal swab or urine, blood tests for HIV and syphilis). No need for them to wait.

That completes the two follow-up exchanges included with each question and so ends this thread. I hope the discussion has been helpful. Most important, I hope you have learned some things that will lead to different actions in event of future symptoms or other reasons to suspect you have an STD. Happy holidays!

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