HPV with male patient

[uhuh]

Any specialist for suspected HPV with a male patient?

Recurrent small erosion (1mm) at the glans, for about 8 weeks,  treated with fungicidal cream and antibiotic cream without success.

The patient has a history of close contact (roommate with shared bathroom, no intimate contact) with someone who turned out to have HPV 16 with oozing ulcerations. (This roommate probably got it from girls in Colombia.)

Dr Niyom at Bumrungrad as well as Dr Somboon at St Louis gave steroid creams for 2 weeks.

After discontinuing the cream the lesion showed again. Dr Niyom suggests circumcision. In his opinion,  HPV has to be a wart. But said roommate didn't have a wart, he had a small erosion at the foreskin for about a year.

 

Any suggestions,  especially from Sheryl?

Thx

 

 

Edited December 12, 2019 by uhuh

[scubascuba3]

Doesn't sound like HPV. Look up Chancroid which is a possibility

[Sheryl]

Agree it does not sound like HPV and also non-sexual  transmission unlikely unless they were literally sharing towels one right after the other.

 

Chancres are not indurated but rather sort of raised and soft so doesn't sound like it.

 

Forgetting the roommate with HPV, does your friend have any risk factors for an STI?  As primary syphilis comes to mind unless tests have already ruled it out. However chancre from syphilis would heal on its own within 2 months even without treatment (the syphilis remains, but the initial sore disappears). A simple rapid blood test that checks for TPHA antigen can rule this in or out.  Posisble one of the doctors already did that. 

 

It sounds like Dr. Niyom thinks it may be due to  irritation from the  foreskin. Is his foreskin rather tight? The fact that the lesion improved with steroid cream and then recurred when it stopped makes it probable this is some sort of inflammatry process.

 

I suggest he see this urologist at Bumrungrad and get his opinion. If it is due to irritation from the foreskin, there are alternatives to full circumcision , google preputioplasty.

 

https://www.bumrungrad.com/doctors/Viroj-Chodchoy

[NCC1701A]

2 hours ago, uhuh said:

But said roommate didn't have a wart, he had a small erosion at the foreskin for about a year.

this might sound overly simplistic, but cut out all intercourse, condoms, masturbation and see if things improve. (like i have) 

 

basic trouble shooting eliminating basics first.  go to a real hospital, don't talk about your issue, and get tested for every known STD on the planet. Don't let them tell you what you need. The lab tests are costly, and the "real" ones take at least a week to get results.     

 

was there any discharge from the erosion? any chance of a sample being taken?

 

does not sound like it, but don't rule out non STD inflections like streptococcus. 

[Sheryl]

He has already been to a "real" hospital and seen an excellent dermatologist who obviously did not think it was an STD and treated it with steroid creams which indicates he also did not believe there was a bacterial infection present.

 

it improved on steroids then recurred after stopping them which supports the idea that it was a due to irritation. The dermatologist suggested tight foreskin might be to blame. I have suggested he see urologist.

 

 

[NCC1701A]

4 minutes ago, Sheryl said:

He has already been to a "real" hospital and seen an excellent dermatologist who obviously did not think it was an STD and treated it with steroid creams which indicates he also did not believe there was a bacterial infection present.

 

it improved on steroids then recurred after stopping them which supports the idea that it was a due to irritation. The dermatologist suggested tight foreskin might be to blame. I have suggested he see urologist.

 

 

yes i agree with you Nancy. i would like to add that some simple things like riding a scooter day in day out or bicycle, increased heat and humidly, just sitting in your chair the wrong way for hours can add to this irritation.

[uhuh]

Syphilis tests are pending. 

(There was unprotected oral sex,  and vaginal sex using condoms.)

There was no discharge. 

Dr Niyom recommended to keep it dry because the foreskin is rather long (hence the idea of circumcision), he seems to think it's some irritation. 

It's a good idea to see a urologist.

 

Thank you,  Sheryl,  for the alternatives to circumcision.

The guy with HPV had a circumcision because he had developed a penile intraepithelial neoplasia, the circumcision (pain for several days) and it's  long term results (not so much fun as before when having sex) were not nice. 

[samuttodd]

If it is HPV,  take white vinegar and dab it on the affected tissue for about 5 minutes.    If it gets white,   then burn it off with a hot nail,  or you can use a topical acid called condylox.