Playing Doctor




Initial Visit?

Tuesday, April 18

The Soft Bulletin

Stockholm and I are supposed to meet tonight, but when I get home from work the Firefighter calls.

‘Hey Erik,’ he says and asks me for a favor. ‘This is rather embarrassing.’

He tells me he’s developed a rash ‘down there.’ He has several painless bumps over a single red area at what sounds like the corona. He noticed it about five days ago. He admits to only one sexual encounter in the past six months and it occurred one week before the rash came up.

‘Do you want me,’ I ask, ‘to look at your penis?’

We both laugh, uncomfortably.

‘Well, I can see my doctor tomorrow,’ he says, ‘but the more I think about it, the more I’m freaking out about it.’

I tell him to come over, then call Stockholm and reschedule our date for tomorrow, telling her something’s come up. I don’t tell her it’s my ex-boyfriend’s diseased penis.


When the Firefighter gets to my house he tells me the full story.

He knows exactly one other firefighter whom he suspected to be gay and they’ve always been friendly, if not exactly friends. So he suggested they meet for a beer and ended up meeting the firefighters’s ‘friend.’ So far reasonable enough, right? But then he and the other guy’s friend start playing footsie under the table. At some point they exchange numbers and the friend started text messaging him the next day, eventually texting him an invitation to his apartment.

So he goes over, expecting to meet—he tells me—them both, but it’s just the friend. Blah blah-blah. Now he has a rash.


The differential for sexually transmitted diseases that cause a rash is not terribly long: Syphilis, Chancroid, Herpes, Donovanosis, Lymphogranuloma venereum. Some things can also enter the differential, depending on the history and appearance of the lesion: Mulluscum contagiosum, HPV, Scabies and trauma (carpet burn/denim sore).

Of those, what will you actually see in practice? Well, in my practice, I see none of them. Right now, I specialize in sepsis, crack chest pain, and brain hemorrhages. I only see STD’s in patients with advanced AIDS, where they take on Three Mile Island proportions.

But doctors who do see genital rashes mostly see rashes caused by Herpes. The next most common thing they see is—well—herpes. After that, they occasionally see herpes. Syphyllis and what-have-you are all pretty rare. Herpes is pretty common.



We go into my bathroom and I turn the lights up bright, I get gloves out of my medical bag and put them on. I sit on the edge of the bathtub and have him drop his shorts while standing directly in front of me.

The Firefighter’s lesion looks worse than this but not as bad as this. There’s a collection of clear vesicles over an area of erythema, but the whole thing looks crusted over. The vesicles look like herpes. But herpes doesn’t crust over.

‘Have you been putting anything on this?’ I ask.

‘Most everything I can find in the medicine cabinet,’ he says, embarrassed and horrified at the situation.

That would explain the crusting. Convincing for herpes now, except for one thing.

‘It doesn’t hurt or sting or even itch?’ I ask.

‘Nope,’ he says.

Herpes hurts. It’s painful. I roll the shaft of his penis up with my gloved hand. I also check for any inguinal lymphadenopathy. Nothing.

I sigh his name sadly, squinting at the lesion, and say ‘this looks like herpes.’

He grunts, numbly.

I have him pull his shorts up as I remove my gloves and wash my hands. He walks back into the den.

‘Mind if pour myself a drink,’ he asks and pours us both some scotch.

I check my copy of Fitzpatrick’s Atlas of Dermatology and my Hopkins ABX Guide. I call the Marquee and run the case by him, hoping I can come up with a convincing alternative diagnosis.

‘I don’t know, dude,’ the Marquee says, ‘it sounds pretty convincing.’

I tell the Firefighter that I might be wrong and that he should see his family practitioner the next day. He agrees to do so, but I know he doesn’t take my protest very seriously.

‘I suspect you’re right,’ he says. Mulling some idea, while the scotch warms his mouth. He laughs a bit. He tells me a story from his college years about a friend who pursued someone for nearly two years and when she finally slept with him, ‘all she got out of it was a bad case of herpes. We laughed about it then… I’m feeling a little differently about that story now.’

‘I don’t mean to sound,’ he says, ‘like I am feeling a lot of self-pity here. But since I decided to come out, I’ve been thinking how I was finally going to explore this and have some fun. That’s not going to happen now.’

I refill our glasses.

‘I even rented some gay porn last Saturday. It was good’ he says, with strong emphasis on the word good. ‘It was called The Young Gods. I was jerking to it for over two hours.’

‘Two hours?’ I say, incredulously, ‘porn flicks don’t last two hours.’

‘Um,’ he says, shamefacedly, ‘I rewound some of the scenes and watched them twice.’

‘Two hours?’ I say. ‘What’d you use for lube?’

‘Spit and pre-cum’

‘For two hours?’ I say, trying not to sound like a parent scolding a child. A friction rub wouldn’t explain the vesicles, but it might explain some of it. ‘Make sure you tell your doctor tomorrow about that.’

He remains unconvinvced and by the end of the evening, we polish off most of my bottle of Glenlivet 21.

5 Comments:

4/18/2006
Anonymous Anonymous writes:

I beat myself up over "getting herpes" only to find through Internet research that my symptoms (a painless scab on my shaft) pointed to the new bathing suit I'd worn on a cruise the week before and not herpes.

I occurance of herpes freak-out over casual dick trauma must be in the billions!

 


4/18/2006
Blogger the other sarah writes:

I bet you hear "Hey Erik, this is embarrassing, but..." alot...

 


4/18/2006
Blogger dan writes:

Purple penis is almost more disturbing than herpe penis. Almost.

Is carpet burn on a penis pretty common?

Penis penis penis.

 


4/24/2006
Blogger little sister writes:

I clicked the links for examples of diseased penises while reading your blog at work. When I closed out internet explorer some time later, a small diseased penis remained on my computer desktop. Thank you, doctor.

 


5/01/2006
Blogger Erik writes:

You're welcome. I always say, if I can touch just one person...

 


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