[Question #448] Dermatitis of the Penis

33 months ago
In 2009 I engaged in unprotected sex with someone and thought I contracted hsv-2. I was tested in 2009 and this past year in 2015 using the IgG test for both hsv-1 and hsv-2. All stds including hsv-1 and hsv-2 came up negative. My penis is red with small bumps and has been numb since then. It is usually numb throughout the day and sometimes subsides. I asked a question before to someone at this forum here and the nurse responded that it was Balanitis and concluded that with 98% certainty for hsv-2 testing, no hsv-2. Seeing as how this was acquired after sex, I believe it may be a fungal infection. I went into a walk in Clinic and they prescribed me some Clotrimazole. I've applied it for two weeks, however there has been no improvement. Could you please help me? I've uploaded an image and I hope you're able to see it.
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
33 months ago
Welcome back to the forum. Thanks fo ryour question. I agree this isn't herpes for sure, both from your description and the negative blood test.

The large majority of penile dermatitis is not due to any STD. I also disagree that just because it came on after sex, it might be fungal. Yeast and other fungal infections generally are not sexually acquired. And lack of response to clotrimazole also is good evidence against a fungal cause.

Most likely this problem is entirely unrelated to your sexual exposures. Near my left elbow as I write this is an atlas of genital dermatology. It's about 290 pages long. Only about 15 pages are devoted to STDs. Some genital skin problems are those that can occur anywhere on the body and happen to involve the genital area, whereas others are specific to the genital area. But not sexually acquired.

With apology, we do not examine posted photos on this forum. As described clearly on the opening pages of the forum, we do not provide direct medical care and are not a substitute for it. We only provide general information, whereas examining photos comes too close to diagnosis from afar. My advice is that you see a physician about it, ideally a dermatologist, and take it from there. In the meantime, you really needn't be worried about herpes or any other STD.

I hope this has been helpful. Best wishes--  HHH, MD


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33 months ago
Thank you for your response. I hope I'm not being intrusive, but is there any other advice you could give me? I live in Canada by the way. I went to see my family Doctor, he then sais I'm fine. He then sent me to see a Uroligist, he sais I'm fine. This has been detrimental to my sex life and mental self. Are there any dermatoligists in Canada that you could recommend? Do you think I should get circumcised? 
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
33 months ago
I'm not sure what else I can suggest. We don't make referrals to specific physicians, and in any case I don't have experience with any Canadian dermatologists.

It would seem there is a disconnect between how severe the problem seems to you and your doctors' opinions. Is this really something that is so painful or otherwise bothersome? But if you have what seems to be significant balanitis (the medical term for inflammation of the head of the penis and under the foreskin), most urologists would recognize that cirumcision sometimes has a role in solving it. OTOH, that step often is limited to men with phimosis -- constriction that prevents complete retraction of the foreskin. However, I have no way to judge whether circumcision could be part of the answer in your case.

In any case, all this is getting off the focus and intent of this forum. We deal specifically with STDs, not with non-STD genital problems. But I hope some of my perspectives have been helpful. Best of luck with it.

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33 months ago
It is quite bothersome. Once again, I thank you for your insight My Handsfield. I'm aware this is not an std problem per se, but it has caused a great deal of physical pain with my sexuality and has occurred since a sexual exposure. Since 2009, my penis has been incredibly numb. So numb, I would want to take a knife and cut my penis off.  I researched phimosis, but I do not have that. I'm able to retract the foreskin. Would it be possible to come to the United States for a consultation with you? This problem has led me to severe depression since 2009 and suicidal ideation to some degree. Would there be any more advice you might be able to give me? Thanks again. I'm in severe pain...:(
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
33 months ago
I am retired from active practice and no longer have a day job or a clinic. And in any case, this still would be outside my expertise -- not an STD problem. If I came across a patient with these problems when I was clinically active, I would have referred him to other providers. One of them probably would be a psychologist or psychiatrist. And that reflects my final advice, as you requested:  since neither your family doctor nor a urologist apparently found a physical explanation, as well as the level and kind of distress you report, I have to suspect that a large part of your problem is psychological. That might be a path for you to consider pursuing professionally.

That concludes the two follow-up quesitons permitted for each new question, and so ends this thread. For sure put any concerns about STDs aside. Best wishes to you.


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