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Have ulcerated skin under foreskin of penis, surrounding skin turned solid white, swollen. STD negative. What is it ?

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have ulcerated skin under the XXXXXXX of my penis is about 3 inches now, surrounding skin is turning solid white.. 4 days ago the infected area was grayish, bluish, and very swollen, now it is raw skin and bloody. no STD was detected from blood and urine tests. had unprotected sex 10 days ago. noticed swollen area about 5 days later.
Posted Tue, 22 May 2012 in Sexually Transmitted Diseases
 
 
Answered by Dr. Gaurang Krishna 15 hours later
Hello,

Thanks for writing in.

This is a very well defined and clean looking ulcer.

The differentials that come into my mind are primary syphillis and Fixed drug eruption. I would also like to rule out Chancroid.

The STI tests may have been normal as they were done early and the disease may have been in the window period.

I would suggest you to visit a dermatologist again and get your self tested.

The tests would include- VDRL, DGI, Gram's Stain, HIV ELISA, Hep B and Hep C, Chlamydiae antigen and antibody.

If the ulcer is painless, chances of syphilis are high.

If they started after taking a medicine like antibiotic/pain killer then chances of FDE are high.

If the ulcer is painful and you have swollen glands in your groin then chances of chancroid are high.

Nevertheless, you must get yourself tested for every possibility as clinical examination alone is correct only in 60% of cases.

Please keep me posted

Thanks
Above answer was peer-reviewed by
 
Follow-up: Have ulcerated skin under foreskin of penis, surrounding skin turned solid white, swollen. STD negative. What is it ? 6 hours later
Hello Doctor XXXXXXX
Thank you for taking on this case. I went through a new round of testing today and visited 3 clinics because the first clinic started pumping me with some IV drip, prescriped Valtrex, and some topical ointment, Arasena A (googled it as Vidarabine).

So, I called another doctor who thought this was suspiscous, since now this is my 3rd drug prescirbed, by the first clinic since Friday the 23rd..and no changes.

He asked me to see a dermatologist. She scrapped a sample and used a microscope and ruled out fungal infection but did not rule out herpes. So she said would be best to take the Valtrex as the other doctor prescribed and instead of this Arasena-A, use another topical ointment, Jpn name is Aznol, but maybe it is Tacrolimus hydrate 0.03%.

Then I went finally to a new doctor who my friend said was very good when he had STD. This doctor ruled out all STI and said it was an allergic reaction from antibiotic or pain medicine, (I had a cold 4 days before this ulcer and took a few different meds, Alkaseltzer cold medicine, Avelox, and Allegra meds I had from the states, as I am in Japan now ).

This sounds like your diagnosis of a fixed drug eruption. The ulcer is very painful when it rubs against my clothes, or even water is touches it. Does this rule out syphillis?

Thank you. It is really been a crazy trip down the medical world. I am thinking to stop all meds, and take what this last doctor gave me as the allergic reaction.
10mg tablets of Cetirizine Hydrochloride, 1 tablet before bed for 10 days.
A topical of mix of Actosin 3% and Delmozole 0.12% maybe Japanese name, generic name googled, is maybe (Betamethasone valerate).

Does this last choice sound good? If so, how many days with this treatment do you think before I should see some improvment. I really hope this works.
Regards,
Z
Follow-up: Have ulcerated skin under foreskin of penis, surrounding skin turned solid white, swollen. STD negative. What is it ? 39 minutes later
Hi,
This new medicine, Actosin 3% is Bucladesine sodium, and mix of this Bucladesine sodium, as soon as I applied it, it burned like crazy and blood started erupting.
Anyways..this is what I applied and will try out.
Thanks
Z
 
 
Answered by Dr. Gaurang Krishna 16 hours later
Hello.

Thanks for following up.

The final diagnosis sounds pretty good to me.

Syphilis is ruled out and this is not herpes.

I agree with your decision of sticking to the last treatment.

If we do not see an improvement in 10 days or so, we will review your case again

All the best
Above answer was peer-reviewed by
 
Follow-up: Have ulcerated skin under foreskin of penis, surrounding skin turned solid white, swollen. STD negative. What is it ? 52 minutes later
Hi again,
Thank you.
Will do!
 
 
Answered by Dr. Gaurang Krishna 31 minutes later
Thanks.

Please keep me posted about the progress..
Regards
Above answer was peer-reviewed by
 
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