Hi again. Further to my query a few months ago, I had some further questions based on recent events. The previous issue cleared up several days after my last message; however, I have had a recurrence. As last time it seemed to have been a fungal infection, I self-medicated with topical clotrimazole cream for 4-5 days but there was no improvement. Again, there were the raised whitish areas/pimples but this time it actually was worse than the first time. Went back to the urologist who prescribed me a combined anti-fungal/bacterial/steroid cream pending lab results, as well as oral flucozonale (2 doses, 1 week apart). (The swabs this time were negative for bacteria/fungal but I was using topical clotrimazole cream at that point so the Urologist said this is not definitive). The whitish sores/pimples have receded but there remains a lot of inflammation/soreness/slow healing even after 8 days, so the urologist advised to see a dermatologist. Dermatologist advised me to stop taking the ointment as 8 days should have been enough if it was fungal, but that she still suspects herpes even after the negative HSV2 blood test in June as if it was fungal it should have cleared by now and the positive candida result in June may have been secondary/coincidental. She has taken a PCR swab and also given me an HSV1 blood test - results pending; however, she said that as I've been using the topical cream the PCR swab may not be 100% accurate. Again, with my sexual history this is all rather strange to me, however, she is saying I could have acquired HSV1 genitally from my wife in the course of oral sex. Anyway, I am now using a new herpes focused topical treatment as she has prescribed.

Sorry, one other comment. Another reasons I'm not sure about a possible herpes diagnosis as that at no point has there been any scabbing, which I though was typical of herpatic sores? Again, not sure if that is correct or not.

Quick update: the STD 10 Panel Real Time PCR was negative for all items tested, including HSV1 and HSV2. I don't know how reliable this is. I still have redness/tenderness around the entire area, although it seems to be very slowly healing. 

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Hi. Thanks for the response. I am not based on North America so unfortunately not sure if the Western Blot will be an option.

HSV1 Blood Test Results

So I saw another Dermatologist today as a follow up who acknowledged it was a challenging case. He says Candida can be ruled out given the oral flucozonale and topical anti-fungals used. He is sceptical of Herpes as he said it was more generalised redness/soreness verses specific localised sores, especially given the blood tests and that it hadn't seemed to respond the topical treatment over 3 days. He also said that my lymph nodes around the groin were normal (not swollen). He said Zoon's Balinitis was another possibility but that my age makes that unlikely and also that Zoon's would have responded to the steroid cream used for several days. He noticed some weeping/discharge/wetness in the affected area under the foreskin below the glans and he suspects a bacterial infection of some kind that did not show up on the earlier tests. He has put me on doxycycline for 2 weeks and advised to stop all topical application except a non-medicated moisturising/nappy rash sort of cream to help the area heal and to monitor over the next several days. He also gave me another urine test and is reperforming the swabs/PCR tests. He mentioned Chlamidya at one point but again that doesn't make sense given my sexual history.

One other quick addition. Now that I have stopped using the different topical applications, it seems to be evident that there is some sticky yellow discharge around the area. I am not sure if it is from the urethra or the inflamed area under the foreskin. Would this support the diagnosis of a beacterial infection of some kind?

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