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Suggest Treatment For Diarrhea And Haemorrhoids
Question: Dear Dr. Batra,
I am a 24 year old male medical student and am going through a disconcerting event. I am looking for an honest opinion on the atypical presentations of herpes. I have studied herpes quite extensively in school and on my own. I also have consulted other doctors who do not think I have anything to worry about but most physicians who do not deal with herpes or have studied it do not realize that 83% of symptoms go unnoticed.
One week ago at around 3am Sunday I was involved in a threeway. I received oral sex flaccidly for 2-4 minutes and then stopped the encounter. I also had one bout of diarrhea on Monday.(could have been due to old eggs) 1.5-2 days later I experienced tingling at the tip of the penis. I would describe it as a hypersensitivity on the top portion of my glands and a slight burn when I urinated. It was uncomfortable for my glans to rub against my boxers/jeans. I took oral 1000mg of Azithromyocin at 8pm Tuesday. Wednesday at around 3:30 I did a urine test at my doctor and received 250mg i/m of ceftriaxone. The urinalysis, culture, and Chlamyida and Gonnoreah tests were all negative. Till Thursday morning the tip was red and i would describe as increased wrinkles from the top portion of my urinary meatus down to the base of the glans. I began putting topical Neosporine on my penis 3-5x daily Thursday, Friday and Saturday. The hypersensitivity and improved but is still present but the wrinkles and increased lines are still there. The mild erythemetaous has also improved.
A few other symptoms that may or may not be related.
On Wednesday I noticed a blood on my toilet paper. I have had hemorrhoids before but not recently and it just seemed inconvenient timing since genital herpies can infect the anus. These have been slightly irritating the past day and half but a lot of times I do not notice them unless I am wiping.
Wednesday I developed slight irritation in my groin area. I can see bilateral red lines in the area where my scrotum sits. Also my scrotum is a little more erythematous. I did wear warm pajama pants to bed to avoid uncomfortable contact, normally i wear just boxers, and probably did sweat considerably since I took something to help me sleep and slept 11 hours.
Symptoms of my friend who was involved in the incident:
My friend involved developed swollen lymph nodes or tonsils(his words) 24 hours later and then felt 2.5 days of “ cold and fatigued”. Tonsils/ilness(could be due to partying all weekend). 5 days later he developed a possible cold sore on lip. This maybe his first one....he cannot remember.
My last STI test in mid november was negative for HSV1 and HSV2 as well as all other tests. I have not slept with anyone else except my current partner since September 18th. She has tested clean in October.(though i do not know if they tested for HSV since it is not a normal test unless asked for)
I know i can wait for a IgG test in 6-12 weeks but I am taking my boards in a few months and I am finding it difficult to concentrate. I am aware that there is no 100% way to confirm a herpes diagnosis without a lab exam but I was hoping to get your best opinion. If it herpes then I will have to accept that but I would rather know now or at least know its more probable then be shocked a month before my board exams.
The symptoms i have described all seemed to wax and XXXXXXX The hypersensitivity on my glans, noticing the hemorrhoids/(herpes). I know the brain is powerful and I may just be hyperfocusing at certain points or not at all.
Do any of these symptoms seem like an atypical primary herpes manifestation?
I am a 24 year old male medical student and am going through a disconcerting event. I am looking for an honest opinion on the atypical presentations of herpes. I have studied herpes quite extensively in school and on my own. I also have consulted other doctors who do not think I have anything to worry about but most physicians who do not deal with herpes or have studied it do not realize that 83% of symptoms go unnoticed.
One week ago at around 3am Sunday I was involved in a threeway. I received oral sex flaccidly for 2-4 minutes and then stopped the encounter. I also had one bout of diarrhea on Monday.(could have been due to old eggs) 1.5-2 days later I experienced tingling at the tip of the penis. I would describe it as a hypersensitivity on the top portion of my glands and a slight burn when I urinated. It was uncomfortable for my glans to rub against my boxers/jeans. I took oral 1000mg of Azithromyocin at 8pm Tuesday. Wednesday at around 3:30 I did a urine test at my doctor and received 250mg i/m of ceftriaxone. The urinalysis, culture, and Chlamyida and Gonnoreah tests were all negative. Till Thursday morning the tip was red and i would describe as increased wrinkles from the top portion of my urinary meatus down to the base of the glans. I began putting topical Neosporine on my penis 3-5x daily Thursday, Friday and Saturday. The hypersensitivity and improved but is still present but the wrinkles and increased lines are still there. The mild erythemetaous has also improved.
A few other symptoms that may or may not be related.
On Wednesday I noticed a blood on my toilet paper. I have had hemorrhoids before but not recently and it just seemed inconvenient timing since genital herpies can infect the anus. These have been slightly irritating the past day and half but a lot of times I do not notice them unless I am wiping.
Wednesday I developed slight irritation in my groin area. I can see bilateral red lines in the area where my scrotum sits. Also my scrotum is a little more erythematous. I did wear warm pajama pants to bed to avoid uncomfortable contact, normally i wear just boxers, and probably did sweat considerably since I took something to help me sleep and slept 11 hours.
Symptoms of my friend who was involved in the incident:
My friend involved developed swollen lymph nodes or tonsils(his words) 24 hours later and then felt 2.5 days of “ cold and fatigued”. Tonsils/ilness(could be due to partying all weekend). 5 days later he developed a possible cold sore on lip. This maybe his first one....he cannot remember.
My last STI test in mid november was negative for HSV1 and HSV2 as well as all other tests. I have not slept with anyone else except my current partner since September 18th. She has tested clean in October.(though i do not know if they tested for HSV since it is not a normal test unless asked for)
I know i can wait for a IgG test in 6-12 weeks but I am taking my boards in a few months and I am finding it difficult to concentrate. I am aware that there is no 100% way to confirm a herpes diagnosis without a lab exam but I was hoping to get your best opinion. If it herpes then I will have to accept that but I would rather know now or at least know its more probable then be shocked a month before my board exams.
The symptoms i have described all seemed to wax and XXXXXXX The hypersensitivity on my glans, noticing the hemorrhoids/(herpes). I know the brain is powerful and I may just be hyperfocusing at certain points or not at all.
Do any of these symptoms seem like an atypical primary herpes manifestation?
Brief Answer:
None of these symptoms are suggestive of herpes
Detailed Answer:
Hello. Thank you for writing to us
I have gone through your query and I have understood your concern.
Well, none of these symptoms which you have experienced recently, ever since you had a risky sexual encounter, don't seem to suggest anything related to herpes. Tingling at the tip, hypersensitivity of glans, redness at tip, increased wrinkling of glans and bleeding from haemorrhoids etc are not suggestive of herpes.
Herpes classically presents with sores/ erosions which may be multiple, discrete Or confluent, dry or with some Oozing and usually small sized. There is associated pain, burning sensation and burning on passing urine.
Prodromal symptoms like tingling, shooting pain, discomfort etc in perineal region may precede herpetic sores but are not the only symptoms that an episode of herpes limits itself to. Prodromal symptoms are almost always followed by an episode of genital sores. Since you never had sores therefore these symptoms are certainly not due to herpes.
Having said that, herpes may remain clinically silent for weeks or months and it is always best to get screened for herpes after a risky sexual encounter.
At present your symptoms don't seem like those due to herpes.
Regards
None of these symptoms are suggestive of herpes
Detailed Answer:
Hello. Thank you for writing to us
I have gone through your query and I have understood your concern.
Well, none of these symptoms which you have experienced recently, ever since you had a risky sexual encounter, don't seem to suggest anything related to herpes. Tingling at the tip, hypersensitivity of glans, redness at tip, increased wrinkling of glans and bleeding from haemorrhoids etc are not suggestive of herpes.
Herpes classically presents with sores/ erosions which may be multiple, discrete Or confluent, dry or with some Oozing and usually small sized. There is associated pain, burning sensation and burning on passing urine.
Prodromal symptoms like tingling, shooting pain, discomfort etc in perineal region may precede herpetic sores but are not the only symptoms that an episode of herpes limits itself to. Prodromal symptoms are almost always followed by an episode of genital sores. Since you never had sores therefore these symptoms are certainly not due to herpes.
Having said that, herpes may remain clinically silent for weeks or months and it is always best to get screened for herpes after a risky sexual encounter.
At present your symptoms don't seem like those due to herpes.
Regards
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Dear Dr. Kakkar,
Thank you for the quick response. They are always looking for us to use the rule of parsimony, explain multiple symptoms with one diagnosis. Hence the jock itch, hemorrhoids and gland rash. This may not be in your field of specialty but do the anal images look like fissures?
Do you know if a primary herpes outbreak will spread to multiple sites or just to the initial site? I know it goes in the skin and begins to replicate. Then moves to spinal nerves.
If initial contact had been a penis.Does it go the spinal nerve roots and spread to other areas such as anus or thighs during primary outbreak? or is that during a secondary outbreak?
Finally based on the image i sent you of penis do you have any idea what could cause the change? Could it be fungal or HPV or another cause? I can not seem to find any thing that describes increase wrinkles at the head.
Thank you for the quick response. They are always looking for us to use the rule of parsimony, explain multiple symptoms with one diagnosis. Hence the jock itch, hemorrhoids and gland rash. This may not be in your field of specialty but do the anal images look like fissures?
Do you know if a primary herpes outbreak will spread to multiple sites or just to the initial site? I know it goes in the skin and begins to replicate. Then moves to spinal nerves.
If initial contact had been a penis.Does it go the spinal nerve roots and spread to other areas such as anus or thighs during primary outbreak? or is that during a secondary outbreak?
Finally based on the image i sent you of penis do you have any idea what could cause the change? Could it be fungal or HPV or another cause? I can not seem to find any thing that describes increase wrinkles at the head.
Brief Answer:
Genital herpes can happen away from the site of acquisition
Detailed Answer:
Hi.
No. I cannot make out any anal fissures. Anal fissures usually involve the anal opening, at least in part, which is not the case here.
Haemorrhoids can cause perianal itching and infact, it is the area around anal opening that has an irritated patch of skin and a few erosions over it, probably due to scratching.
Primary herpes can involve the scrotum as well as the anal region apart from involving the penis and pubic region. Seconday and recurrent epsiodes are usually of lesser severity and more localised than a primary episode.
Yes, it is possible to have a herpes away from the site of acquisition Or away from the site of direct contact e.g genital herpes may present with perianal sores even though their is no history of anal sex.
The image of glans shows that it is extremely dry and therefore seems wrinkled. No, intervention is required for this issue. It is not fungal infection or Hpv. I suggest you to avoid using harsk soaps etc to clean the glans.
Regards
Genital herpes can happen away from the site of acquisition
Detailed Answer:
Hi.
No. I cannot make out any anal fissures. Anal fissures usually involve the anal opening, at least in part, which is not the case here.
Haemorrhoids can cause perianal itching and infact, it is the area around anal opening that has an irritated patch of skin and a few erosions over it, probably due to scratching.
Primary herpes can involve the scrotum as well as the anal region apart from involving the penis and pubic region. Seconday and recurrent epsiodes are usually of lesser severity and more localised than a primary episode.
Yes, it is possible to have a herpes away from the site of acquisition Or away from the site of direct contact e.g genital herpes may present with perianal sores even though their is no history of anal sex.
The image of glans shows that it is extremely dry and therefore seems wrinkled. No, intervention is required for this issue. It is not fungal infection or Hpv. I suggest you to avoid using harsk soaps etc to clean the glans.
Regards
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Thank you for your help. Final question: how long should I wait/expect for the head to heal before I reach out to a dermatologist?
Also how would you recommend I treat my irritation on the inside of my thigh? I am not sure if it is Jock Itch or just irritation?
Thanks
Also how would you recommend I treat my irritation on the inside of my thigh? I am not sure if it is Jock Itch or just irritation?
Thanks
Brief Answer:
Use a steroid+antifungal combination cream for groins
Detailed Answer:
Hi.
You don't have to worry about the glans. Just don't bother about it. Its fine already except for some dryness. Just try to avoid using any soaps etc.
I suggest you to apply a topical antifungal+steroid combination cream (clotrimazole %+beclomethasone dipropionate 0.025%) twice daily for your thighs, for 2 weeks. It looks like a start of fungal infection; it is right at the groin folds which provide an ideal site for the fungus to grow because the sweat gets trapped here.
Regards
Use a steroid+antifungal combination cream for groins
Detailed Answer:
Hi.
You don't have to worry about the glans. Just don't bother about it. Its fine already except for some dryness. Just try to avoid using any soaps etc.
I suggest you to apply a topical antifungal+steroid combination cream (clotrimazole %+beclomethasone dipropionate 0.025%) twice daily for your thighs, for 2 weeks. It looks like a start of fungal infection; it is right at the groin folds which provide an ideal site for the fungus to grow because the sweat gets trapped here.
Regards
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Thank you for all your help.
Oh I see I can't end follow up if I typed a response. Sorry about that.
Oh I see I can't end follow up if I typed a response. Sorry about that.
Brief Answer:
You are welcome
Detailed Answer:
Thank you for writing to us
Regards
You are welcome
Detailed Answer:
Thank you for writing to us
Regards
Note: Consult a Sexual Diseases Specialist online for further follow up- Click here.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
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