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Hey Doctor For The Last 14 Days I Have Had

Posted on Thu, 19 Dec 2019

Question: Hey doctor for the last 14 days I have had a fungal infection on both the glans/foreskin and shaft of my penis. My primary symptoms where a red rash on the shaft and also the glans/foreskin plus a white discharge from the glans. The shaft rash and symptoms have completely vanished and I’ve used the antifungal cream for 12 days on both now. The discharge from the glans is also gone, but I’m left with a bit of balanitis(redness) on the foreskin and glans mainly. Originally I was just using Canesten Anti-fungal Cream on both the glans/foreskin and shaft and it’s seemed to work great but it hasn’t helped the redness on the glans/foreskin so my doctor has prescribed me Hydrozole for the glans/foreskin how long does it generally take to bring down the redness with this cream and how long is it safe to use for would you say? How much should I be applying only a small amount? Also my doctor mentioned if it doesn’t work I’d have to take the one off Fluconazole 150mg oral tablet how long should I give it before going down that route as I’d rather not take the oral medication because I tend to have bad stomach problems and apparently you can’t take antihistamines at all with it why is that? I’ve also been having intercourse with my girlfriend in the last week is this okay to do with a condom? My GP told me it generally won’t spread to my partner so it would be fine, would oral sex be okay as well?

Thanks in advance for you help it’s much appreciate!

Answered by Dr. Dr. Antoneta Zotaj (2 hours later)

Brief Answer:
Detailed answer to your questions below

Detailed Answer:
Hello and welcome to Ask a Doctor service,
I carefully read your query and understand your concern.

Hydrozole contains hydrocortisone (which helps with redness and irritation) and clotrimazole (which helps with the fungal infection). You should notice improvement with this cream in 2-3 days of starting it.

You should apply a thin layer in the affected area and 2 cm beyond it twice a day.

If the local treatment is not enough then oral Fluconazole single dose is given. I understand your concerns with the risk of stomach upset with Fluconazole use but this is a single dose and if taken after food the chance for problems with the stomach is very slim.
You should try to eat frequent small meals on the day you take the pill to avoid stomach upset (if the doctor prescribes Fluconazole).

I am not sure why you were told fluconazole can not be taken with antihistamines, there is no interaction between these two drugs and they can safely be taken together.

On the other hand, it is not antihistamines that are recommended to prevent stomach upset due to medications. We generally recommend omeprazole 20 mg 30 minutes before breakfast in these cases.

If you use a condom, there is no risk of yeast infection transmission or local irritation so it is a good decision you are having to use condoms.

I hope this answers your query and is helpful to you. Let me know I can assist you further.

Regards,
Dr. Antoneta Zotaj,
General and Family Physician.

Above answer was peer-reviewed by : Dr. Yogesh D

Follow up: Dr. Dr. Antoneta Zotaj (2 hours later)

Hey doctor, would the addition of the hydrocortisone do much to aid in the infection or just reduce the redness? I’ve used it for a full day now and I haven’t noticed too much improvement but my foreskin does feel kind of “loose” in a sense from having it on and ive now noticed a red spot on the centre of the foreskin also after applying it. Once I start to see improvement with the Hydrozole at what point can I stop it, once the redness is gone or? Can I also then switch back to just the antifungal and if so how long for being that I’ve been on it for 12 days now can these infections sometimes take a while to get over the only thing is I thought they were quite uncommon in men? In terms of antihistamine I was using it for my hay fever allergies as this time of the year is quite bad for it.

In terms of the drug interaction this is what I was talking about;

https://www.ncbi.nlm.nih.gov/m/pubmed/0000/

Also with the Hydrozole and antifungal cream in the leaflet it is advised not to latex condoms but it has not mention of non latex I assume this is fine? I have attached where it says in the leaflet along with it below

https://www.ebs.tga.gov.au/ebs/picmi/picmirepository.nsf/pdf?OpenAgent&id=CP-2018-CMI-02227-1&d=0000

Answered by Dr. Dr. Antoneta Zotaj (2 hours later)

Brief Answer:
Detailed answer below

Detailed Answer:
Hello and welcome back,

The interaction of fluconazole with new antihistamines is if fluconazole is given in high doses and not in the usual dose or in single-dose as you may be taking it. So, you do not need to worry and you can continue the use of antihistamines with no risk of any major interactions.

Some creams may reduce the effect of latex-condoms. Because the non-latex condoms are not mentioned, the use of non-latex condoms should be fine while you use hydrozole cream (hydrocortisone/clotrimazole cream).
As for the effect of the hydrozole cream (hydrocortisone/clotrimazole), you will need 2-3 days before you determine if it is helping you or not. If it is helping you, it is recommended to use it for 5-7 days.

I hope this answers your query and is helpful to you. Let me know I can assist you further.

Regards,
Dr. Antoneta Zotaj,
General and Family Physician.

Above answer was peer-reviewed by : Dr. Prasad

Follow up: Dr. Dr. Antoneta Zotaj (31 hours later)

Thanks for that doctor in terms of intercourse would it be advisable to wash the cream off before doing so if for example I applied the cream in the morning at 9am and had intercourse later at night at 10/11 should I just wash it off in case? Also how long can these infections generally take to heal I have noticed some more improvement in terms of the redness in the glans and foreskin however it’s still it completely better I’ve pretty much been using antifungal cream for 2 weeks now including the Hydrozole is this out of the ordinary or normal?

Answered by Dr. Dr. Antoneta Zotaj (2 hours later)

Brief Answer:
Detailed answers below

Detailed Answer:
Hello and welcome back,

If you have applied the cream in the morning and you are going to have intercourse in the evening you may choose to gently rinse it off with warm water but it is generally not necessary as the cream should have been absorbed and there should not be left much cream at that time.
The thing that you have to be cautious about is that you need to use non-latex condoms.

As for the time it will take, the yeast infection should be healed by 7-10 days of starting an antifungal. In your case, because you are seeing improvement with the new cream, hydrozole, I would advise to just give it a few more days. If you notice that the rash is not greatly improved in a total of 5-7 days of using hydrozole or if you notice any new symptoms or any worsening, please see your doctor again to decide on further treatment.

I hope this answers your query and is helpful to you. Let me know I can assist you further.

Regards,
Dr. Antoneta Zotaj,
General and Family Physician.

Above answer was peer-reviewed by : Dr. Vaishalee Punj

Follow up: Dr. Dr. Antoneta Zotaj (21 hours later)

Hey doctor thank you for the follow up, I just had a few more things to ask. Would you have any general hygiene tips that might help speed up the healing process? Would things like older underwear or using the same towel prolong the infection? So far I’ve had 12 treatment days with the antifungal cream and now 3 days with the Hydrozole and all though it has improved it still there by the looks of it. I’m just a little worried that maybe the fungal infection is resistance to treatment? It’s super annoying to deal with and worrying me as well especially when it should of healed by now right? Every time I have sex as well and although not that often it seems to make the area red again even when I’m using a Condom which I’m unsure if it’s a setback or not?

Follow up: Dr. Dr. Antoneta Zotaj (2 minutes later)

Do you think it’s worthwhile giving the Hydrozole cream a couple more days and if not going back to my doctor and trying the oral route of treatment?

Answered by Dr. Dr. Antoneta Zotaj (3 hours later)

Brief Answer:
Detailed answers below

Detailed Answer:
Hello and welcome back,

Thank you for your reply. It is my pleasure to assist you.

As for general hygiene:
- there is no problem with old underwear as long as they are cotton and not worn out.
- it is recommended to change underwear daily
- just wash locally with warm water, no soaps or cleansing products (as these may cause local irritation and worsen the rash)

As for the treatment:
- it is true that yeast infection should have healed in 7-10 days
- on the other hand, you are trying a different antifungal with the new cream and a steroid which seems to be giving some effect.
- normally with a treatment (hydrozole for instance), improvement should start within the first 2-3 days and complete healing takes a week so I would recommend you to give a couple of days and if you are not satisfied with the result you will need to see the doctor
- yeast infection is not dangerous, it is bothersome but it does not cause long term damages
- the redness when you have intercourse can be due to engorged blood vessels during erection and this may make the redness more pronounced.

So, to conclude, it is safe to wait another couple of days and see your doctor if you are not much better with the treatment.

I hope this answers your query and is helpful to you. Let me know I can assist you further.

Regards,
Dr. Antoneta Zotaj,
General and Family Physician.

Above answer was peer-reviewed by : Dr. Vaishalee Punj

Follow up: Dr. Dr. Antoneta Zotaj (11 hours later)

Hey doctor thank you for the follow up I really appreciate your time as this has got me a little worried not having had it before. With this fungal infection originally I was getting white discharge from the glans that was my main symptom along with a red rash on my shaft but the original cream I used completely fixed all of that within a week. Is it possible that the fungal infection has actually been cured and I’m now just having balanitis as the aftermath or even because of the cream is that possible? Originally I was diagnosed in the first place via a swab test that was taken of the glans and foreskin that confirmed the infection which was 15 days ago would doing another swab be worth it?

Follow up: Dr. Dr. Antoneta Zotaj (2 minutes later)

Also I’ve read the creams won’t do much better than nothing for Balantis is that true even the steroid ones as well?

Answered by Dr. Dr. Antoneta Zotaj (4 hours later)

Brief Answer:
Detailed answer below

Detailed Answer:
Hello again,

I understand your concerns as this is lasting.
I am quite reassured that you had a swab that confirmed yeast infection. We have to rule out other causes of penile lesions such as STDs first.
If the swab confirmed this is yeast infection, this is reassuring.
Creams help with balanitis in a good number of patients, so they are tried first and oral antifungals given if local creams do not help enough (which is the case in a small number of patients).
If you are concerned you may ask your doctor to give you the oral tablets. this will resolve the infection quickly and will reduce your stress.
As for balanitis being due to the cream, this is the case if a patient develops an allergic reaction to the cream. In this case, the redness gets worse with the application of the cream and may cause swelling, itchiness, etc.

It is my pleasure to assist you. Feel free to let me know if you have further questions.

I wish you a quick improvement,
Regards,
Dr. Antoneta Zotaj

Note: Hope the answers resolves your concerns, however for further guidance of skin related queries consult our Dermatologist.Click here to book a consultation

Above answer was peer-reviewed by : Dr. Prasad