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Dr. Andrew Rynne

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Had unprotected sex. Red bumps and burning feeling on penis tip. What to do?

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Dr. Sudarshan

Dermatologist

Practicing since :2005

Answered : 1391 Questions

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Posted on Thu, 20 Dec 2012 in Skin Hair and Nails
Question: I had unprotected sex over a year ago. 27 year old male. Circumcised. A couple weeks after, I had an incredible burning at the tip of my penis with some redness. Red rash and nearly invisible red bumps nearly covered penis head. Blood test confirmed HSV1 (no history of cold sores). First doctor confirmed herpes. Put me on 500mg Valtrex. No relief. One month later, went to Dermatologist. He said it was not herpres. Gave me steroid cream and 1g Valtrex for 6 months to be sure. Pain and redness never subsided. Pain and burning spread to anus, back of legs. At the 1 year XXXXXXX went to another dermatologist. He also said it is not herpes. Gave me Clotrimazole and Betamethason Cream. No relief. Went back, he gave me Lidocaine HCL3% and Hydrocortisone Acetate .5% cream and Rx for Neurontin. Two months of that. No relief. Been in incredible pain with visible redness on penis glans for over a year. Don't know what to do.
doctor
Answered by Dr. Sudarshan 8 hours later
Hi,
Thanks for writing in.
I can understand your agony and will try to help you to my best.

The condition you are describing can be herpes genitalis/ plasma cell balanitis/candidial balanitis/erythroplasia of queyrat,post herpetic neuralgia.

Also I would like to know-
Did you had lesions all over the penis or just half side in your first episode?
Have you been tested for Herpes IgG and IgM antibodies for herpes 1 and 2?
Have you been tested for HIV?When ?how many times ?by which test?
Do you have pain in groin or swelling/lymph glands in groin?
Is pain continous or it comes in episodes?
Is the redness present continously or it comes and goes?
Has any of the above treatment decreased the pain and symptoms?
Can you post photos of the affected area?

Photos can help a lot in predicting the condition.
Photos can be uploaded by using UPLOAD YOUR REPORTS SECTION.

Answer the questions and upload the photos so that we can continue our discussion here.

Awaiting your response.

DrSudarshan
MD Dermatology.
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Sudarshan 7 hours later
Thank you for your reply.

I will answer your questions in the order asked:
1. I never had lesions. No blisters. Just a red rash. The first of three doctors was the only one to diagnose herpes from the appearance of a "blister" on my urethra. That tiny shiny spot changes, never erupts, and appears sporadically all day.
2. I was tested for herpes 1 and 2. Positive for herpes 1. I have never had cold sores on my mouth. Just this red burning rash in the pictures
3. I was tested twice for HIV two weeks after the incident. Negative
4. Just painful groin area. No swelling.
5. Mostly continuous pain. For more than one year. Some days is better/worse than others.
6. Redness is present always. Sometimes it is splotchy, sometimes it covers my whole glans. Some days it's dark red. Some days it's hard to see.
I should also mention that, in concert, I have periods of great pain on my buttocks, back of legs. No rash or anything. Just pain.
doctor
Answered by Dr. Sudarshan 18 hours later
HI ,

Thanks for the details and photos Ive gone through them.
At present it does not look like any STD or herpes.
The erythema or redness is also very minimal.

Pain radiating to buttocks ,legs suggests a sacral radiculopathy and neuralgia rather than herpes.
Did you had any relief with neurontin?
Is your Xray spine/MRI spine done ?

If sacral ganglia are affected by herpes it can give rise to pain in buttocks ,back of legs,perianal area.
Some neurotrophic agents like methylcobalamine,pregabaline are worth trying .
Also Amitryptaline is a wonderful drug which works wonderfully in such condition.
Some surgical procedures can also be tried.

Discuss this options with your doctor.A consultation with a orthopedic surgeon is worth taking.

Hope this helps.
Regards.


Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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