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Suggest Treatment For Burning Sensation And Intermittent Pain On Penis
Question: Dear doctor, thank you all your wonderful help in this site.
BACKGROUND
I am writing to you because un monday afternoon (7 days ago) i had protected CASUAL anal sex (give and receive), but had unprotected oral sex (give and receive). My sexual partner (male) had 1 round flat red coloured lesion between lip and chin but said it was not herpes (i am not 100% percent sure it is true). I also took 100mg viagra pill that day before sex (i am not used to taking viagra).
Afterwards i got nervous and since i did not had a shower or bathroom nearby i applied an aromatic hand sanitizer on penis shaft and tip and also moist kleenex towel (for cleaning babies) around tip.
SYMPTOMS
Since then, 1-2 days afterwards i have been having this burning sensation in the tip of my penis. I don't feel any pain, fatigue or even fever, but i have this persistent intermittent pain for almost 5 days now and laso feel quiet frequently the need to urinate. No other symptoms and at least for now no pain during urination, at least no noticeable pain.
Whenever i smoke marijuana i feel burning sensation stronger. I read somewhere that marijuana (THC) increases blood flow (even to penis area).
ABOUT ME
Things you may need to know:
1. I am a frequent marijuana smoker (I smoke 1 regular sized joint every night after work).
2. I am HIV+ currently on successful HAART with undetectable VL and 550 CD4 and 43% CD4%.
3. I was diagnosed with HPV warts on march 2014 and they were surgically removed but site where some of the warts have stayed a bit inflamed afterwards leaving what feels like bumps in 3 areas (i went back to urologist for this and he said it was inflammation response of the skin to surgical removing of warts and i should not worry).
4. Other than that good health and good overall frequent blood lab tests (CBC, liver, kidney, etc).
5. I masturbate regularly (almost once a day on average).
TESTS PERFORMED after 4 days of possible exposure:
1. Urine Culture: negative results for common pathogens looked for in test (lab does limited search for parasites in this type of test).
2. Urine PCR for CHLAMYDIA and GONORRHEA: still waiting for results
3. Urine Test (NOT PCR) for HSV 1 and 2: still waiting for results.
CONSULTATION QUESTIONS FOR REVIEWING DOCTOR
1. If ONLY SYMPTOM is irritated penis opening (urethra), it probably is due to applying hand sanitizer while under effects of viagra and marijuana to penis tip. How long can irritation from hand sanitizer last? Can it last more than 7 days? It started about 6 days ago and still continues today.
2. If burning sensation started about 6 days ago but still no lesions have appeared nor have any other symptoms appeared, can it be safe to say que there is a low probability it might be herpes? I read somewhere that burning sensation from herpes infection is called a prodromal symptom of herpes and lesions/sores usually appear 2-3 days after prodromal symptoms, therefore i would conclude there is a low chance this might be herpes since this irritation has lasted for almost 6-7 days with any sores.
3. Whenever i smoke marijuana i feel burning sensation stronger. I read somewhere that marijuana (THC) increases blood flow (even to penis area). Can this irritation lasting mora than 6 days could have been exacerbated (elongated) by smoking marijuana?
4. In your professional opinion, taking account my medical history (HIV+ on successful ARVs and was diagnosed with HPV in past), and my possible exposure and symptoms, what would be your best GUESS as to what it causing this burning sensation?
5. Finally, before I go to see a Dr. here I want to get all my lab tests done first so that can see him with results ready. What other test would you recommend me doing (don't worry about me spending on tests) to test what might be causing this symptoms?
6. Can this be due to chlamydia/gonorrhea, herpes (prodomal) symptoms?
7. Could it be a simple irritation of the urethra because of the hand sanitizer??? Is it normal for this burning sensation to last this long if it was due to the aromatic hand sanitizer?
8. Could this be prodromal symptoms (pre-outbreak) of herpes virus? I was told it probably was not herpes because an outbrake would have followed 1-3 days after burning sensation. No outbrakes as of yet. Do you think it might be herpes considering my symptoms?
9. Could receptive anal sex might have inflamed the prostate which would cause frequent urges to urinate and probably urethitis?
10. What other STD might give my symptoms?
11. How accurate is Urine PCR test for chlamydia? Will it be accurate 4 days post possible infection date?
12. How accurate is Urine PCR test for gonorrhoea? Will it be accurate 4 days post possible infection date?
13. How accurate is simple Urine test for Herpes? Will it be accurate 4 days post possible infection date?
14. If symptoms continue what type of doctor would you recommend me seeing?
15. Finally, if all tests come back negative should i re-take them again and after how many days? Should i perform anymore tests other than the ones i already did?
Thank you very much for all your help.
BACKGROUND
I am writing to you because un monday afternoon (7 days ago) i had protected CASUAL anal sex (give and receive), but had unprotected oral sex (give and receive). My sexual partner (male) had 1 round flat red coloured lesion between lip and chin but said it was not herpes (i am not 100% percent sure it is true). I also took 100mg viagra pill that day before sex (i am not used to taking viagra).
Afterwards i got nervous and since i did not had a shower or bathroom nearby i applied an aromatic hand sanitizer on penis shaft and tip and also moist kleenex towel (for cleaning babies) around tip.
SYMPTOMS
Since then, 1-2 days afterwards i have been having this burning sensation in the tip of my penis. I don't feel any pain, fatigue or even fever, but i have this persistent intermittent pain for almost 5 days now and laso feel quiet frequently the need to urinate. No other symptoms and at least for now no pain during urination, at least no noticeable pain.
Whenever i smoke marijuana i feel burning sensation stronger. I read somewhere that marijuana (THC) increases blood flow (even to penis area).
ABOUT ME
Things you may need to know:
1. I am a frequent marijuana smoker (I smoke 1 regular sized joint every night after work).
2. I am HIV+ currently on successful HAART with undetectable VL and 550 CD4 and 43% CD4%.
3. I was diagnosed with HPV warts on march 2014 and they were surgically removed but site where some of the warts have stayed a bit inflamed afterwards leaving what feels like bumps in 3 areas (i went back to urologist for this and he said it was inflammation response of the skin to surgical removing of warts and i should not worry).
4. Other than that good health and good overall frequent blood lab tests (CBC, liver, kidney, etc).
5. I masturbate regularly (almost once a day on average).
TESTS PERFORMED after 4 days of possible exposure:
1. Urine Culture: negative results for common pathogens looked for in test (lab does limited search for parasites in this type of test).
2. Urine PCR for CHLAMYDIA and GONORRHEA: still waiting for results
3. Urine Test (NOT PCR) for HSV 1 and 2: still waiting for results.
CONSULTATION QUESTIONS FOR REVIEWING DOCTOR
1. If ONLY SYMPTOM is irritated penis opening (urethra), it probably is due to applying hand sanitizer while under effects of viagra and marijuana to penis tip. How long can irritation from hand sanitizer last? Can it last more than 7 days? It started about 6 days ago and still continues today.
2. If burning sensation started about 6 days ago but still no lesions have appeared nor have any other symptoms appeared, can it be safe to say que there is a low probability it might be herpes? I read somewhere that burning sensation from herpes infection is called a prodromal symptom of herpes and lesions/sores usually appear 2-3 days after prodromal symptoms, therefore i would conclude there is a low chance this might be herpes since this irritation has lasted for almost 6-7 days with any sores.
3. Whenever i smoke marijuana i feel burning sensation stronger. I read somewhere that marijuana (THC) increases blood flow (even to penis area). Can this irritation lasting mora than 6 days could have been exacerbated (elongated) by smoking marijuana?
4. In your professional opinion, taking account my medical history (HIV+ on successful ARVs and was diagnosed with HPV in past), and my possible exposure and symptoms, what would be your best GUESS as to what it causing this burning sensation?
5. Finally, before I go to see a Dr. here I want to get all my lab tests done first so that can see him with results ready. What other test would you recommend me doing (don't worry about me spending on tests) to test what might be causing this symptoms?
6. Can this be due to chlamydia/gonorrhea, herpes (prodomal) symptoms?
7. Could it be a simple irritation of the urethra because of the hand sanitizer??? Is it normal for this burning sensation to last this long if it was due to the aromatic hand sanitizer?
8. Could this be prodromal symptoms (pre-outbreak) of herpes virus? I was told it probably was not herpes because an outbrake would have followed 1-3 days after burning sensation. No outbrakes as of yet. Do you think it might be herpes considering my symptoms?
9. Could receptive anal sex might have inflamed the prostate which would cause frequent urges to urinate and probably urethitis?
10. What other STD might give my symptoms?
11. How accurate is Urine PCR test for chlamydia? Will it be accurate 4 days post possible infection date?
12. How accurate is Urine PCR test for gonorrhoea? Will it be accurate 4 days post possible infection date?
13. How accurate is simple Urine test for Herpes? Will it be accurate 4 days post possible infection date?
14. If symptoms continue what type of doctor would you recommend me seeing?
15. Finally, if all tests come back negative should i re-take them again and after how many days? Should i perform anymore tests other than the ones i already did?
Thank you very much for all your help.
Brief Answer:
Visit a sexual health specialist/venereologist
Detailed Answer:
Hello. Thanks for writing to us at healthcaremagic
I have gone through your query and I have understood it.
Salient points in your history are:
-HIV positive
-Protected anal sex and unprotected oral sex
-Burning sensation at the tip and frequent desire to urinate
Protected sex is considered to be safe in terms of most STD's except for Genital Herpes, Warts and Molluscum Contagiosum.
Unprotected Oral sex is definitely a risk factor for Genital Herpes; Gonorrhea and chlamydia rarely can acquired by the oral route because the organisms can infect the throat as well as the oral cavity of the person giving oral sex.
Herpes has a short incubation period of 4 days (range 2-12 days) and presents with discrete, well defined erosions along with pain and burning sensation.
There is burning sensation on passing urine as well. This prodrome is usually immediately followed by typical lesions of herpes.
Therefore considering these facts, I will keep a likely diagnosis of non-gonococcal urethritis (irritation to hand sanitizer of the delicate urethral mucosa lining the tip Or it could possibly be due to chlamydia); gonorrhea is less likely because of the lag period (gonorrhea has a short incubation period of 3-5 days and usually has a purulent urethral discharge). Herpes is still a possibility.
PCR for gonorrhea and chlamydia is generally highly accurate within a few days but if symptoms persist for 2 weeks PCR should ideally be repeated again as previous test might have been too soon to be taken as conclusive.
Urine test for herpes can be performed on urine in the absence of herpetic lesions. The test is basically meant to detect viral antigens on the surface of cells infected with the herpes virus. It is not very commonly performed. It should be followed by a blood test for antibodies.
You may visit a sexual health specialist/venereologist if the symptoms persist or if the tests reveal an STD.
Your specialist might decide to treat you empirically for non-gonococcal urethritis with a course of an oral antibiotics
Regards
Visit a sexual health specialist/venereologist
Detailed Answer:
Hello. Thanks for writing to us at healthcaremagic
I have gone through your query and I have understood it.
Salient points in your history are:
-HIV positive
-Protected anal sex and unprotected oral sex
-Burning sensation at the tip and frequent desire to urinate
Protected sex is considered to be safe in terms of most STD's except for Genital Herpes, Warts and Molluscum Contagiosum.
Unprotected Oral sex is definitely a risk factor for Genital Herpes; Gonorrhea and chlamydia rarely can acquired by the oral route because the organisms can infect the throat as well as the oral cavity of the person giving oral sex.
Herpes has a short incubation period of 4 days (range 2-12 days) and presents with discrete, well defined erosions along with pain and burning sensation.
There is burning sensation on passing urine as well. This prodrome is usually immediately followed by typical lesions of herpes.
Therefore considering these facts, I will keep a likely diagnosis of non-gonococcal urethritis (irritation to hand sanitizer of the delicate urethral mucosa lining the tip Or it could possibly be due to chlamydia); gonorrhea is less likely because of the lag period (gonorrhea has a short incubation period of 3-5 days and usually has a purulent urethral discharge). Herpes is still a possibility.
PCR for gonorrhea and chlamydia is generally highly accurate within a few days but if symptoms persist for 2 weeks PCR should ideally be repeated again as previous test might have been too soon to be taken as conclusive.
Urine test for herpes can be performed on urine in the absence of herpetic lesions. The test is basically meant to detect viral antigens on the surface of cells infected with the herpes virus. It is not very commonly performed. It should be followed by a blood test for antibodies.
You may visit a sexual health specialist/venereologist if the symptoms persist or if the tests reveal an STD.
Your specialist might decide to treat you empirically for non-gonococcal urethritis with a course of an oral antibiotics
Regards
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Thank you Dr. Kakkar,
Let me see if I understood you correctly:
1. Your best guess would be NGU due to chemicals from hand sanitizer.
2. There is still a chance it might be Herpes, but not too likely since I have been having these symptoms 2 days after exposure and today (8 days after still no outbreak or new symptoms). Simple urine test might not be accurate specially 4 days after exposure, if symptoms persist must do test again in urine plus blood test for antibodies. If i have herpes I WILL KNOW and after 2 weeks of exposure if there aren't sores or lesion it will be very little chance of having herpes.
3. Chlamydia or Gonorrhea very little chance but still a chance. PCR test in urine for both done 4 days after exposure will likely have accurate results.
4. For now nothing else to do and wait for tests already performed and monitor symptoms. No need to visit a specialist as of yet unless new symptoms or symptoms don't go away.
Is this all correct?
FINAL QUESTIONS
1. If urethritis is caused by irritation from strong hand sanitizer and/or spermicide from condom, how long CAN burning symptoms last? Its been about 6-7 days, they aren't getting any worse or better.
2. Would you avise to wait about 4 more days (total 14 days after exposure) before seeing a specialist here unless symptoms worsen before that?
Thank you!
Let me see if I understood you correctly:
1. Your best guess would be NGU due to chemicals from hand sanitizer.
2. There is still a chance it might be Herpes, but not too likely since I have been having these symptoms 2 days after exposure and today (8 days after still no outbreak or new symptoms). Simple urine test might not be accurate specially 4 days after exposure, if symptoms persist must do test again in urine plus blood test for antibodies. If i have herpes I WILL KNOW and after 2 weeks of exposure if there aren't sores or lesion it will be very little chance of having herpes.
3. Chlamydia or Gonorrhea very little chance but still a chance. PCR test in urine for both done 4 days after exposure will likely have accurate results.
4. For now nothing else to do and wait for tests already performed and monitor symptoms. No need to visit a specialist as of yet unless new symptoms or symptoms don't go away.
Is this all correct?
FINAL QUESTIONS
1. If urethritis is caused by irritation from strong hand sanitizer and/or spermicide from condom, how long CAN burning symptoms last? Its been about 6-7 days, they aren't getting any worse or better.
2. Would you avise to wait about 4 more days (total 14 days after exposure) before seeing a specialist here unless symptoms worsen before that?
Thank you!
Brief Answer:
May wait for 3-4 days.
Detailed Answer:
Hi.
1) Apart from hand sanitizer I have also kept a possibility of Chlamydia and is I was the treating doctor I would have treated you empirically for it with antibiotics (Doxycycline)
2) Herpes may not always present immediately after infection and it may be clinically silent therefore a blood test at 2 weeks.
3) PCR should ideally be done at 2 weeks. Performing it too soon may give a false negative result. Therefore I said that if symptoms persist, you may need to repeat it at 2 weeks.
4) You may wait for the test report as of now
5) Since the symptoms have persisted for 6-7 days and if they persist for another 3-4 days, as I also mentioned earlier I would have treated you empirically with doxycycline for NGU.
Regards
May wait for 3-4 days.
Detailed Answer:
Hi.
1) Apart from hand sanitizer I have also kept a possibility of Chlamydia and is I was the treating doctor I would have treated you empirically for it with antibiotics (Doxycycline)
2) Herpes may not always present immediately after infection and it may be clinically silent therefore a blood test at 2 weeks.
3) PCR should ideally be done at 2 weeks. Performing it too soon may give a false negative result. Therefore I said that if symptoms persist, you may need to repeat it at 2 weeks.
4) You may wait for the test report as of now
5) Since the symptoms have persisted for 6-7 days and if they persist for another 3-4 days, as I also mentioned earlier I would have treated you empirically with doxycycline for NGU.
Regards
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Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Answered by
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