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Have penile lesions. STD tests negative. Tried antibacterial and antifungal creams. Cause?

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I am 28 yrs old Male, uncircumcised. I have been experiencing some form of rash on the head of my penis for over 9.5 months now. I had small tiny painless dots and went to a hospital here in Taiwan and the Urologist told me that I have a fungal infection but he gave me "Tricodex". It contained Neomycin Sulfate 3?, Diphenylpyraine XXXXXXX 1?, Nylidrin HCl(Buphenine)1?, and Hydrocortisone 5?. It seemed to work but within a couple of days the dots returned.

Another visit to another hospital's Urologist said the same thing and this time prescribed Sertaconazole which did not seem to work. I did not have any discharge or fever it was mainly a burning sensation and comestic problem for me. I kept on using Tricodex but the problem persisted. I also tried other anti fungal creams including Clotrimazole and Miconazole. I also took Ketaconazole orally and Fluconazole 150mg as a single dose. None of them cured the problem.

I can easily retract my foreskin all the way and wash it twice everyday and dry it properly. In March I finally saw a Dermatologist and she did a KOH test for candida and it was negative. She said it might be due to the fact that I've been medicating it so gave me Cutivate Cream to see if it would get better. It didn't help. I saw her again the next week and she did another KOH test and it was again negative. She said it didn't seem like a bacterial infection because there would be some discharge or pus so she said lets try Sertaconazole and see what happens. Sometimes it seemed like it went away but its always present if I look down there.

Being desperate I started to look at natural alternatives. I somehow believed I was still infected with Candida so I tried Gentian Violet down there. Big mistake as it gave me ulcer like wounds! I saw the doc and she prescribed some cream and with some time off it healed just fine. However, the original dots are still there.

I then went to a laboratory clinic and did a full panel STD test. AIDS(HIV)-1/2 Ab, RPR(STS) Test, TPHA(TPPA), Syphilis DNA(PCR), HSV DNA(PCR), Trichomonas DNA(PCR), Chlamydia DNA(PCR), Gonorrhea DNA(PCR), Candida DNA(PCR), HPV-DNA(PCR)(Typing), HPV High Risk ratio 0.33. Everything came back negative and I was well out of range for all window period. I also did a urine sample and everything came back just fine. The doctor took a sterile cotton and swabbed the irritated area around the head of my penis and did a culture. The result showed no Yeast or Parasites but found high levels of Staph and E-Coli. They also found out which antibiotics would work and I took the report back to my dermatologist and she was kind of not convinced by the report and told me to try Gentamycin cream anyway.

I tried the cream for a couple days and the redness and swelling lessened a lot. I was pretty convinced I was being cured. Until about a week later small red spots came up again. I did research and read that fungal infections are caused by an imbalance of good/bad bacteria so I thought maybe the use of antibiotics on my penis caused a fungal infection. I then started applying Sertaconazole on it but it didn't seem to help. I went back to lab and cultured myself there again. This time the report showed no E-Coli but still high on Staph and that this time Gentamycin was negative in reaction. I needed either Vibramycin (+) or Minocycline (2+)

I took the report to the dermatologist and she said the report isn't convincing because there could be contamination and Staph can be found anywhere on human. She's kind of unsure of what I have and suggested maybe I should get a biopsy done to see what's wrong. She said it would be very painful so I'm unsure about that......

I took the report to another dermatologist and she looked at my skin and said it doens't look to be infectious (it was not as irritated as the pictures when I showed her) She said it doesn't look that bad and if it wasn't giving me symptoms (at the time it wasn't) I should leave it alone. I wasn't convinced and showed her the report of my culture and she said its not reliable because it could be contaminated. She then did a KOH herself and looked under the microscope and said can't find any candida and it looks like healthy skin to her. She told me to leave it alone and see what happens. I was thinking maybe I've over medicated myself or had an allergic reaction to one of the many creams I've used. The most effective cream I've used this 9 months is a cream that consists of Nystatin, Neomycin Sulfate, and Triamcinolone Acetonide. But she said using steroid cream there long term is certainly not recommended.....

I've left my penis alone for the past week or so only sometimes applying some Vitamin E cream on it. I can masturbate just fine and have sex just fine but especially after activities the penis gets very red and the spots get very irritated. Not only is the spot irritated it has also spread to more areas around the head. Just yesterday a new spot near my urethra appeared and is causing me burning sensation while sitting and also while urinating.

A year prior to this I was prone to getting boils and had those cultured which was Staph. (actually had like boil a month over a period of 8 months) It finally stopped after this course of antibiotics. I'm pretty vulnerable to these little infections but is overall a quite healthy and athletic male.

I'm somewhat convinced that this is a staph infection and I should take some antibiotics as well as using bactroban on my penis. I did try fusidic cream and tetracycline XXXXXXX but they didn't seem to work at all. The previous dermatologist thinks it may be other causes like lichen planus or herpes but i've never had blisters or pus and i've tested negative for it. I can't neglect the problem because there is definitely something wrong and the problem is getting worse when I've stopped all medication.

Several questions I'd like answered:

*Please note that the penis is real life is about twice as red as it appears on the attached photos. The problematic area is very prominent and can easily separate them from normal skins. The red area seems to be a bit "raised" and it is spreading after I've stopped medicating for 8 days now.

1. What do you think is causing this problem given the information? Could it be penile papules or Fordyce spots? What about plasma cell balanitis? Or other skin conditions such as Eczema, Psoriasis or Lichen Planus?

2. Should I try a course of Vibramycin and Bactroban?

3. Would you recommend doing a biopsy to the find the cause? How long does the biopsy take to heal? Is it that painful?

4. Would circumcision be a solution to this problem?

I'm eager to hear your thoughts and this has given a shot at my confidence level as a male and significantly lowered my sexual drive. Thanks for listening
Posted Tue, 13 Aug 2013 in Men's Health
Answered by Dr. Manuel C See IV 7 hours later
Good Day and thank you for being with healthcare magic!

I am sorry to hear that you have gone through alot in terms of your penile lesions. I have looked at the pictures that you have sent us and i feel like your penile head (glans penis) is irritated at the moment. It could be because of a bacterial infection or a fungal infection. At the moment i would suggest stopping all medications at the moments and washing the area with water and mild soap one or two times aday. Often times the medications make lesions worse and gets it irritated.

Your doctor is right in saying that it is not good to be in long term steroid therapy cause it will lead to secondary bacterial infection.

1. What do you think is causing this problem given the information? Could it be penile papules or Fordyce spots? What about plasma cell balanitis? Or other skin conditions such as Eczema, Psoriasis or Lichen Planus?

Answer: There are alot of possible diagnosis in your condition ranging from benign conditions (normal lesions) to infected lesions (bacterial and fungal). I am thinking you have hirsuties coronae glandis that become irritated and possibly infected. Although a biopsy would give a definite diagnosis.

2. Should I try a course of Vibramycin and Bactroban?

I would suggest to stop medications because it might irritate the area more. I would suggest taking ascorbic acid (Vit C) 500mg every day to encourage healing.

3. Would you recommend doing a biopsy to the find the cause? How long does the biopsy take to heal? Is it that painful?

I would recommend doing a biopsy on the lesions to have a definite diagnosis since you have been suffering for a longtime now. Healing would take 1 - 2 weeks but you would be able to do your normal daily activities during the healing time. It is done on an outpatient basis and under local anesthesia. The area will be numb and you wont feel anything during the biopsy. After the biopsy you will be given pain relievers and possibly antibiotics to prevent infection.

4. Would circumcision be a solution to this problem?

Generally circumcision would not help as long as the penis is kept clean and dry all the time. However if you have this persistent problem i would recommend doing the circumcision and you can do it at the same time with the biopsy.

I Hope I have answered your question and best of luck.
Above answer was peer-reviewed by
Follow-up: Have penile lesions. STD tests negative. Tried antibacterial and antifungal creams. Cause? 16 hours later

I stated in my query that I have actually done KOH test 3-4 times which all came back negative so it surely can't be fungal right?

Wouldn't a bacterial infection be more aggressive with faster spreads, pain, or discharge? My symptom is mainly an asymptomatic rash and some slight burning sensation.

Do you think this can be some kind of contact dermatitis? I've seen several urologist/dermatologists in person here in Taiwan and none of them felt my problem is infection based. Specifically after they've seen my reports of all negative STD tests and a clean urine test as well as multiple KOH negative results.

Answered by Dr. Manuel C See IV 2 hours later
Good day and thank you for being with healthcare magic!

yes i would agree in saying that KOH smear would rule of fungal infection. To me it looks like an irritated lesion from all the different medications that have been applied in the past. Not all bacterial infections spread quickly and some would remain localized and stagnant depending on the virulence of the organism involved.

It could be contact dermatitis from the secretions from your penile foreskin. Like I said earlier anything short of doing a biopsy would be speculation. If you think this lesion is bothering you and you feel that it is a serious condition then I would suggest doing the biopsy. I hope I have succeeded in providing the information you were looking for. Please feel free to write back to me for any further clarifications at: WWW.WWWW.WW I would gladly help you. Best wishes.
Above answer was peer-reviewed by
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