[Question #909] STI providers

60 months ago
Hello doctors
I was hoping to maybe get a recommendation of an institution or provider that would be able to exam my symptoms .  I know Dr Hansfield has offered this on one occasion on another forum and I'm hoping this request  isn't over stepping the parameters of the forum.  I have become very frustrated  with the docs I have  been examed by , they only have visually observed my genitally skin.  One refused to swab the area said it was fungus and the other just said dermatitis no swab.  This was the same area of skin  that was irritated two different times two months apart.
Any provider in the Philadelphia area would  be greatly appreciated.
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
60 months ago
Welcome to the forum. But unfortunately, I'm not sure we can help much. We don't generally make referrals to specific providers. The closest I have come is to inform users about nearby institutions or medical centers where there is STD expertise. the closest that comes to mind for Philadelphia is that the the U. of PA medical school (Penn) has a strong infectious diseases department and undoubtedly good STD expertise. Temple, Drexel, and Jefferson probably do as well.

Beyond that, you don't give enough information for me to judge what kind of provider would be most helpful to you. It may not be an STD expert, but perhaps a dermatologist. And you haven't necessarily had suboptimal care. The most sophisticated diagnosis of skin conditions, genital and elsewhere, often is simply exam by an expert, without any lab tests. In addition, "irritated" skin usually isn't an STD. (On my bookshelf, 2 feet from my left elbow as I type this reply, is a book titlted Genital Dermatology Atlas. Of its nearly 300 pages, only 15 are devoted to STDs.

Sorry I can't be more helpful, but I hope these comments get you started. Best wishes--

HHH, MD
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60 months ago
Doctor Handsfield
Thank you for your response,  I will give a quick synopsis of what been going on with me.  I know this is forum so getting a diagnosis is not what I'm looking for, just wanted to inform you as to why I had my question.
1 I have had a red area on my penis that would appear about once/ twice a year for the last 15 years the area would itch appear to be dry and  self resolve in a weeks time.

2 In Feb had sex with my wife the, only person I have been with last 8 years.  Two days later the irritation was on my penis( under the glads) in the same spot it always was but had pain this time in tip of penis.  Let it go a couple days with no resolve.  Freaked out a little with the thought maybe this area has been herpes all these years and I have ignored it.

3  Went to STD clinic, NP said area looked like yeast and gave me anti-fungal and got blood work for all STD done including HSV 1 and 2.  Neg for all but HSV 1.  Also showed area to Dermatologist two days later she said dermatitis. 

4  With all this info in hand I said ok, worst case I have GHSV1 and was ok with that but two months later exact spot returned on penis.  Also when this spot returned I had severe bowel issues.  Pain in rectum and perineum that radiates into back of legs.  Then had mucus discharge with and with out bowel movement and ribbon stool.  Went to ER for pain they said no outward lesions observed around anus said constipation was my problem.  Went to family Doc two days later showed him "rash" he said fungus(also asked him if this could HSV1 , he told me HSV doesn't effect the genitals which I know is wrong info) and told me go to gastro for bowel issue which I did, had colonoscopy done 10 days later.  They found two small  polyps, Doc didn't think these where causing my issues but said call if issues returned.  After this had Western Blot done through U of Wa. after this results HSV 1 pos HSV2 neg.

5  Bowel issues returned about four weeks after they subsided called gastro told me take fiber, also went to STD clinic asked for PCR swab of anus( I had to find the test for them on the Lab Corp form so my confidence level in them was a little low)  no outward lesions observed  she said inner area of left side of anus looked inflamed only swabbed  area results negative.  Told me I could take Valtrex and see if it helps and wouldn't hurt me to take .  Took the Valtrex  500 mg for 5 days symptoms resolved in 6 days.  Continued to take for next 20 days.

6  5 weeks later pain in tip of penis returns, small  itchy red area on penis same spot, two days later after that anal itch and rectal pain returns no discharge minor pain with bowel movement  with radiating pain.  Pain in tip of penis gone after 4 days and red area gone after 6 days. Rectal pain still present 7 days after it started made appt to see gastro which is next week.  
 Something is going with all this and I just want to know what it is.  Sorry for the length I know it way too detailed and your time is limited. I appeciate your answer to my previous inquiry and would like go to experts in area of Herpes, if the gastro can't find out whats going on.
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
60 months ago
Thanks for the clarifications.

Your recurrent penile rash is not herpes, which simply doesn't appear like you describe and I see no need for you to see an STD specialist or any sort of herpes expert. As in my initial reply, the large majority of penile skin rashes, including recurrent ones, are not STDs. "Dermatitis" is a completely nonspecific diagnosis; it simply means skin inflammation, and is no more useful than saying, for example, that someone has "irritation" of a particular organ, body part, etc. There are innumerable kinds of dermatitis, from eczema to psoriasis to fungal infections to seborrheic dermatitis (same condition as dandruff on the scalp, and can involve the genitals), and any number of others. Lichen planus is a genital-specific dermatitis that is often intermittent or recurrent. Some skin conditions are specific to the genital area, i.e. typically occur only there; others occur anywhere on the body and happen to involve the genitals. (If you have any other kind of dermatitis or unexplain skin symptoms, perhaps the same thing is on your penis.)

If your penile skin is otherwise normal between the obvious inflamed episodes (as I assume from your description), I see no cause for worry. Nothing serious has come of it so far and probably nothing ever will. That it involves your penis doesn't make it any more important than if the same process were on, say, your abdomen or arm. However, if you wish to continue to pursue a more specific diagnosis, the best bet is to settle on a single dermatologist you respect (or perhaps seek out one who is especially experienced in genital dermatology) and see him or her ASAP (within a few days) the next time a definite rash appears. Perhaps repeated such visits would be necessary -- although the more difficulty such an expert has in making a specific diagnosis, the less important and serious it is likely to be.

I have no idea how to explain the intestinal/bowel symptoms, but I am confident they are unrelated to the penile rash and other genital area symptoms. Almost certainly these are entirely separate medical issues. Finally, anal area redness without blisters or ulcers (open sores) rarely is herpes, and pruritus ani (anal itching without obvious cause) is among the most common symptoms experienced by all humans. We all itch down there from time to time, and if examined at the time, redness would be seen. It always clears rapidly on its own. in other words, I doubt you have anal herpes or that the valacyclovir treatment is the reason the problem cleared up while taking the drug.

I hope this has been helpful. Best wishes.

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H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
60 months ago
Another comment on herpes is that recurrent herpes outbreaks involving both the anus and penis would be quite unusual.

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60 months ago
Dr Handsfield
Thank you for your candor and advice given.  I will follow up it with my gastro and heed your advice with regards to a dermatologist if the situation warrants. Ps I am more so worried about my intimacy with my wife with regards to all this , so thanks you again.
Happy 4th
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
60 months ago
Of course you're worried about transmission. That's always the main concern in situations like this, not fear of the personal effects of infection.

But still no worries. Statistically, it is probable your HSV1 infection is oral, not genital. And if genital, there is no realistic risk of transmission, since genital HSV1 is almost never transmitted by genital contact. I've never seen a case of genital HSV1 that was not acquired from a partner's mouth, never genital contact. Further, look how mild your symptoms are. Even if you have herpes, your partner likely wouldn't have anything worse -- and if she did, she could be effectively treated. And assuming you and your wife stay together and remain monogamous, there would be no risk of transmitting to anyone else. 

So you should do your best to move on with no worry about having herpes or any other STD. It's simply not a realistic risk and shouldn't be a concern.

That completes the two follow-up comments and replies included with each question, so ends this thread. I hope the discussion has been helpful.

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