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Experienced painful urination. Have ulcer on urethra. Looked like loose skin. Found red irritated patch inside. What to do?

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General & Family Physician
Practicing since : 2007
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I experienced painful urination this evening. It looks like I have an ulcer on my urethra on the inside of the meatus. Upon closer examination, there looked like a small strand of loose skin was hanging out of the opening and a small, red irritated patch inside.

Here's some history:

I am 40 with type 2 diabetes. I am in otherwise good health.

About a month ago, I was out of town, so I went to an urgent care clinic because of pain in my penis. There were no lesions or blisters -- no obvious symptoms to me of anything. I was diagnosed with a yeast infection. I was also tested for gonorrhea and chlamydia. Both tests were negative.

I also had a separate STD test battery for HSV1, HSV2, gonorrhea, chlamydia, HepA, HepB, HIV, syphilis. All results were negative.

The urgent care doctor prescribed a course of Diflucan -- 4 tablets once every 72 hours and also prescribed Augmentin in case of a secondary infection. I completed the medication as prescribed. The symptoms subsided, but then I started to feel pain again.

I went to my doctor last week. He said I still have a yeast infection. He prescribed one Diflucan pill every day for two weeks and topical OTC anti-fungal cream daily. I had a regularly scheduled visit with my doctor 3 days ago, and I mentioned that my symptoms persisted. I said the yeast looks gone, and my penis was irritated. He recommended cortizone cream.

I have continued the Diflucan and topical cream, since I thought I still say some yeast infection and was still having irritation.

This brings me to about an hour ago when I had painful urination and discovered the ulcer. I am seeking relief here -- this has been over a month of painful irritation and now this ulcer. I am a little freaked out. Any advice appreciated.
Posted Wed, 25 Sep 2013 in Urinary and Bladder Problems
Answered by Dr. Lohit K 4 hours later
Brief Answer:
Diabetes control. Continue diflucan.Good Hydration

Detailed Answer:
Hi Thanks for using XXXXXXX

To summarise your history, Type 2 DM on treatment and fungal infection in urethra and now painful irritation with ulcer.

Since all your STD tests are negative, the treatment target should be the following

1. Strict control of diabetes. You should regularly check your sugar level (fasting and post prandial) and has to be adherent to your medication. Since uncontrolled diabetes raise sugar levels in urine and this prevents healing and can lead to new fungal infection.

2. Medications
A. Diflucan. Continue the treatment as advised by your doctor. This will take care of the present fungal infection and also prevents any new infection. I usually prefer 100mg per day.
B. Continue anti fungal cream for topical use. This will help you to heal the local infection faster.
C. I don't prefer topical or systemic steroid in your case.
D. Take NSAID like Acetaminophen 650mg twice daily to reduce inflammation and hence faster healing.

3. The urine should be dilute and hence drink plenty of fluids. The concentrated urine may lead to stone formation at the ulcer site, and hence bacterial infection can occur. Keep the area dry and sterile to prevent any further infection.

4. The ulcer may be due to fungal infection or due to urethral calculi. So be adherent to your drugs to prevent fungal infection and drink plenty of fluids to prevent stone formation. If the infection does not subside in few days get done culture and sensitivity test to choose other anti microbial agents.

For severe pain at ulcer site, you can use lignocaine gel under aseptic precautions. This will minimise the pain.

Hope this clarified your query. Consult your board certified doctor for further examination and management. You may require to get done urine routine and USG abdomen and pelvis once to look for any other problem.

Feel free to ask me if you have any further queries.
Wish you good health. Take care.

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