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Red spot on the head of penis after having unprotected oral sex. HIV test and syphilis test were fine. Advice

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General & Family Physician
Practicing since : 2009
Answered : 9382 Questions
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Dear Doctor,

two months ago I had unprotected oral sex as well as protected intercourse during which condom broke (not sure how long before I noticed). Nevertheless, as this experience get me really worried I visited a GP two weeks after the accident. Had HIV test and some full urinary test (too early for HIV – I know). After a three weeks of the accident I developed a red and dry spot just above the head of my penis. When that disappeared after a week I started to develop red spot on the head of my penis, so I went to doctor and had a full blood test to look for infections and also syphilis test – all was fine. I think this spot disappeared after a week and then not long after that new spot of the same kind started to develop near the previous spot (start as very small and then grows to the size seen on the picture attached). I have no penis discharge and only ones during this time I had experienced slight pain when ejaculating (masturbation). When I returned back to the GP they said it is not STD and that I should for now take Griseofulvin (orally) and apply miconazole. I am currently in Asia and I am not sure whether the same procedures would be taking place in Europe. I am a bit worried and do not want to be taking tablets that might have no effect on this condition. Do you know what this could be and should I carry on with this medicine or should start taking doxycicline or some other antibiotics? Thank you.
Posted Sun, 17 Nov 2013 in Sexually Transmitted Diseases
 
 
Answered by Dr. Shoaib Khan 1 hour later
Brief Answer:
Correct approach and treatment initiated

Detailed Answer:
Hello sir and welcome.

Thank you for writing in.

I have gone through your query with diligence and looked at the attached image as well. Let me start by saying that spots on the penis are more likely to be absolutely harmless, but otherwise are a sign of infections.

Well here in Europe, the procedure is similar. We first physically examine the patient (which provides a 70 % confirmation on the type of disease, if present), and then follow that with a few laboratory investigations to rule out all the sexually transmitted infections that present in a similar way. In your case infections like herpes, syphilis, etc. Now that all those were ruled out in your case and also because you do not have any other symptoms, the red spots on the glans penis, shaft or scrotum should be suspected to be thrush (a yeast infection). For this reason, your doctor has advised griseofulvin and miconazole. These will both help in clearing the infection, if it is indeed thrush. But if you do not experience a response or improvement within 7-14 days, then you will have to report to your doctor and then we might have to consider introducing antibiotics to your regimen, but as of now, I would say your doctor is on the right path and is following the right approach, one that is similar to what we follow here in Europe.

I hope this information clears your doubt sir. Do not worry, and in the meantime keep your genitals clean and dry, wear loose and comfortable undergarments (preferably cotton), avoid sexual contact and masturbation also. Wishing you a speedy recovery and please feel free to ask my anything, I am always here to help.

Best wishes sir.
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Follow-up: Red spot on the head of penis after having unprotected oral sex. HIV test and syphilis test were fine. Advice 1 hour later
Dear Doctor,

first of all let me thank you for your answer. I would like to add that i did have only hiv and syphilis test - not herpes or any other std test (as doctors believed these are not needed because the spot does not resemble any stds) - but i had the blood test which can detect a presence of possible infection. Your answer suggests that it might be trush or yeast infection - it is indeed possible as i am in the hot and humid environment and my diet is different to what i have been used to previously. Nevertheless, i would like to ask another question and that - because i have never had a trush and because i had this risky sexuall encouter two months ago - what are the possibilities of developing trush as the early signs of HIV? My hiv test was conducted 18 days after possible exposure (result; non reactive 0,19). Is there a chance to develop trush as a syptom of early stage of hiv in the window period (the first spot appeared aprox. 3-4 weeks after the accident) I am sorry for bringing this up or for asking follow up question but i have been worried for some time now. Thanks and all the best.
 
 
Answered by Dr. Shoaib Khan 27 minutes later
Brief Answer:
Unlikely sir

Detailed Answer:
Hello once again.

Please do not apologize for anything, as I mentioned earlier, you can ask me as many questions as you wish. I am here to clear not just this one, but all your health-related queries. I shall only rest knowing that my patient's are now well informed and being treated in a correct manner, that will yield results. So please, feel free to ask me anything, as many times as required to put your mind at ease.

First of all, the general test conducted to detect any infections might not pick up all sexually transmitted infections, but herpes is indeed unlikely based on the image attached, I only mentioned it because I prefer being thorough. Secondly, thrush is the most likely diagnosis.

As for your question, it is unlikely that thrush will be the first symptom or in other words the first signs of a possible HIV infection, as this would not be possible. Immunity only drops much later during the development of HIV, and not this early. So this is most probably just thrush and nothing else.

I am sure you already know this, but by conducting a HIV DUO test 28 days after the exposure/accident, the result reports a 98 % accuracy. So, if this is negative (which I am sure it will be), you are HIV-free and need not worry about this any longer.

I hope I have explained everything in manner best understood by you sir. I would also like to mention again that I want you to feel free to write back to me anytime, regarding any clarifications or information. I am always available to help.

Best wishes.
Above answer was peer-reviewed by
 
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