[Question #2939] Red patches/open sore
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93 months ago
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Hi Dr HHH, I am 27 yr old male, I had sex with my girl friend where i had oral sex and genital rubbing, no penetration. In a week from that I had itching/red rashes on my penis head and urinary tract.
1. The doc prescribed me cream Clotrimazole and antifungal tablets Fluconazole which didn’t cure. Tested for Syphilis, gonnorhea, chlamydia, HSV1 HSV2 Igg Igm, Hepatitis, HIV -All negative
2. 4 months down I noticed a small open sore which is like 5 cm inside the opening of my penis and the left wall of my urinary tract just inside the penis opening is irritated with inflamed penis opening every morning which gradually decreases in hours. Took a swab test of open sore and again did HSV1 and 2 blood test - Both negative
3. 8 months down, Took 1g of azithromicin where the doc suspected NGU.
4. Doc suspected Trich and put me on 2g of metronidazole as single dose and 100mg of doxycycline twice a day for 10 days. I noticed that the rashes on the penis head was gone, but the open sore and irritated tract is still just there with no good cure
5. I took a shot of rocephin,which didn’t seem to work
6. I don’t know if herpes sore stays just like that for more than a year,the doc prescribed 1 g of valacyclovir hcl twice a day for 10 days-Didn’t cure any
7. Did a cystoscopy and doc said there is no problem in bladder. He wants to do an excision biopsy of the open sore to rule out cancer
8. Itchy red patch on penis head which was gone for some months is back now. So nothing has got better rash/open sore/irritated urinary tract opening :( Questions are,
1. What do you think this red rash/open sore and irritation in urethra be? It doesn’t pain all the time and just stings sometimes. And why are these not going away after these antibiotics,can herpes sore stay this long for close to 2 years? Am I missing any treatment/test/medicine?
2. Is this cancerous? Should i go for excision biopsy or still try any medicine? Would the area of excision get healed though it comes in contact with urine?
1. The doc prescribed me cream Clotrimazole and antifungal tablets Fluconazole which didn’t cure. Tested for Syphilis, gonnorhea, chlamydia, HSV1 HSV2 Igg Igm, Hepatitis, HIV -All negative
2. 4 months down I noticed a small open sore which is like 5 cm inside the opening of my penis and the left wall of my urinary tract just inside the penis opening is irritated with inflamed penis opening every morning which gradually decreases in hours. Took a swab test of open sore and again did HSV1 and 2 blood test - Both negative
3. 8 months down, Took 1g of azithromicin where the doc suspected NGU.
4. Doc suspected Trich and put me on 2g of metronidazole as single dose and 100mg of doxycycline twice a day for 10 days. I noticed that the rashes on the penis head was gone, but the open sore and irritated tract is still just there with no good cure
5. I took a shot of rocephin,which didn’t seem to work
6. I don’t know if herpes sore stays just like that for more than a year,the doc prescribed 1 g of valacyclovir hcl twice a day for 10 days-Didn’t cure any
7. Did a cystoscopy and doc said there is no problem in bladder. He wants to do an excision biopsy of the open sore to rule out cancer
8. Itchy red patch on penis head which was gone for some months is back now. So nothing has got better rash/open sore/irritated urinary tract opening :( Questions are,
1. What do you think this red rash/open sore and irritation in urethra be? It doesn’t pain all the time and just stings sometimes. And why are these not going away after these antibiotics,can herpes sore stay this long for close to 2 years? Am I missing any treatment/test/medicine?
2. Is this cancerous? Should i go for excision biopsy or still try any medicine? Would the area of excision get healed though it comes in contact with urine?
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Edward W. Hook M.D.
93 months ago
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Welcome to our Forum. Dr. Handsfield and I share the Forum and as it happened, I picked up your question today. FYI, we have worked together for more than 35 years and uniformly agree on our assessments and advice although our verbal styles tend to vary a bit. I'll be glad to comment. Thanks for your detailed summary of your problem but in reading it several questions occurred to me that I want to verify before I provide a complete answer:
1. Has it been 8 months since your last sex with your GF?. Did the rash that appeared become the open sore that you described or it that a separate process?
2. How long has the sore been present on your penis. Precisely where it is? During the time it has been present has it gotten bigger or smaller? Is it firm to the touch?
Even before I answer the rest of your question, let me assure you that what you describe is not herpes or any other STI. You have had multiple tests for HSV which are negative, proving that this is not herpes. further, the treatments you have received would have resolved and gonorrhea, chlamydia, trichamonas or other STIs that might be present. Further, the history you provide makes it most unlikely that this is syphilis. I suspect it is something other than an STI and is unrelated to your sexual activity with your GF.
I look forward to hearing more from you in answer to the clarifying questions I have asked. EWH
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93 months ago
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Hi Dr. EWH, Thanks for picking up my qst.
1) It's been 2 years since my last sex. The itchy red rash (also looks like patch/small red spots) is on the head of penis which seemed to be cured for 6 mnths but back now and this small open sore is just inside the opening of my penis. Both are separate process.
2) The open sore is just there for 2yrs now, no change in shape and i couldn't touch it as it is 5cm from the penis opening (inside)
3) The left side (inside) wall of my penis looks irritated too, and the penis lips/tract looks swollen every morning and decreases as the day goes
4) Doc wants to do excision biopsy of sore to rule off cancer. I would want to clear things off with medicine as i am scared if the place of excision wouldn't heal as its in the path of urine. Please advise. Do i really need biopsy? Do you think it's cancerous? as i firmly believe this is the result of my sex encounter
5) What could you possibly think these are. What sore stays this long, do i miss any treatment?
6) I am worried if i had delayed my treatment and this made things worse. Though it took 2 yrs, the meds if any i take in the coming days should cure me right?
All these started a week after my sexual encounter and that was my last one till now. I am very confused and don't know what treatment/medicine to take.
I love my profession, but i am not able to concentrate on anything due to this. Please advise on what should be my next step or treatment.
1) It's been 2 years since my last sex. The itchy red rash (also looks like patch/small red spots) is on the head of penis which seemed to be cured for 6 mnths but back now and this small open sore is just inside the opening of my penis. Both are separate process.
2) The open sore is just there for 2yrs now, no change in shape and i couldn't touch it as it is 5cm from the penis opening (inside)
3) The left side (inside) wall of my penis looks irritated too, and the penis lips/tract looks swollen every morning and decreases as the day goes
4) Doc wants to do excision biopsy of sore to rule off cancer. I would want to clear things off with medicine as i am scared if the place of excision wouldn't heal as its in the path of urine. Please advise. Do i really need biopsy? Do you think it's cancerous? as i firmly believe this is the result of my sex encounter
5) What could you possibly think these are. What sore stays this long, do i miss any treatment?
6) I am worried if i had delayed my treatment and this made things worse. Though it took 2 yrs, the meds if any i take in the coming days should cure me right?
All these started a week after my sexual encounter and that was my last one till now. I am very confused and don't know what treatment/medicine to take.
I love my profession, but i am not able to concentrate on anything due to this. Please advise on what should be my next step or treatment.
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Edward W. Hook M.D.
93 months ago
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Thanks for the additional information. I will comment on each of your points below. Before I do, please let me try to make two key points-First, it is unlikely that either of these problems is an STI or in any way related to your last sexual encounter more than two years ago and secondly, you need to trust your doctor and move forward with addressing these concerns. As you point out they are nagging at you and impacting your life and secondly, your fear of what they might be does not change that they are there. Denial and procrastination will only make the problem more challenging to address.
1) It's been 2 years since my last sex. The itchy red rash (also looks like patch/small red spots) is on the head of penis which seemed to be cured for 6 mnths but back now and this small open sore is just inside the opening of my penis. Both are separate process.
From your description this is some sort of dermatological process unrelated to STI. Most rashes occurring in the genital regions are not STIs and for an STI to follow the course you describe would be more unusual. For it to recur in this way would be even more unusual.
2) The open sore is just there for 2yrs now, no change in shape and i couldn't touch it as it is 5cm from the penis opening (inside).
I can't help but wonder how you know it is present almost three inches inside your penis. This location is not consistent with an STI.
3) The left side (inside) wall of my penis looks irritated too, and the penis lips/tract looks swollen every morning and decreases as the day goes
I cannot comment on what this might be but logically it may be related to either your rash or the lesion iside of the penis.
4) Doc wants to do excision biopsy of sore to rule off cancer. I would want to clear things off with medicine as i am scared if the place of excision wouldn't heal as its in the path of urine. Please advise. Do i really need biopsy? Do you think it's cancerous? as i firmly believe this is the result of my sex encounter.
As I said above, it is most unlikely that this is any related to your last sexual encounter. if it is persistent, a biopsy sounds reasonable to me I understand your being nervous about the procedure but it is not going away and you need to find out what it is. If you are truly concerned, you may wish to get a second opinion but my recommendation is to not procrastinate further in addressing this.
5) What could you possibly think these are. What sore stays this long, do i miss any treatment?
I have no idea. I would worry about some sort of chronic dermatologic process or perhaps, as you mention, a tumor. No matter what, you need to find out what it is and get it taken care of.
6) I am worried if i had delayed my treatment and this made things worse. Though it took 2 yrs, the meds if any i take in the coming days should cure me right?
You do not know what you are treating. You need to work with your doctor to address this expeditiously.
I hope these further comments are helpful. Please trust your doctor and/or get a 2nd opinion but whatever you do, I urge you to not procrastinate further. This is not an STI. EWH
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