Suggest Treatment For Rashes On The Penis Head And White Discharge
I am a male 37 years old. I was in XXXXXXX for vaction from early march to mid april. When in XXXXXXX I saw a rash on my penis head and some white stuff. I ignored for 2 weeks to see if it resolves. I saw a doctor and he diagnosed it as Candida Balanoposthitis. He prescribed me an antifungal cream and medication. This made me very sick and I stopped taking it. I waited till I got back home to the US and showed it to my GP. He made the same diagnoses and prescribed me mycolog II and Terbinafine once a day. After taking it for a week I also developed frequent urination. My GP then tested me for chlamydia and gonorrhea which came negative. He tested my urine and found blood and some bacterial infection. He said it is an infection of the prostate. So he put me on 2 weeks of Doxycyline 100mg twice a day and flowmax .4 mg once a day. I took this for 2 weeks and the symptoms did not improve. Other symptoms I have are occasional groin and lower abdomen pain. Mild pain. There is no discharge from penis. He asked me to see a urologist and I got the appointment 2 weeks from now. So my GP asked me to continue on the flomax and doxycycline till I see the urologist.
The situation now is
I am still applying the mycolog II
Taking doxycyline 100 mg twice a day
taking fomax .4 mg twice a day.
taking terbinafine 250mg once a day
I have following questions:
1. I think this is a candida infection of the prostate. Can this be possible?
2. If yes the doxycycline will only make it worse. I took doxycycline for 3 weeks. Can I stop doxycycline, till I see my urologist 2 weeks from now to see if things improve?
3. Is Terbinafine 250mg oral effective on candida
Need to rule out Diabetes .
Detailed Answer:
Hello
Thanks for your query ,based on the facts that you have posted it appears that you have rash over glans penis since couple of weeks and have been prescribed Doxicycline and anti fungal medications which have not worked .
I shall be happy if you can post me few more details to help me in making comments on your problem.
1) Are you diabetic ?
2) Was a swab test of a white material or secretions from glans penis done to confirm diagnosis of Genital Candidiasis ?
3) is it possible to upload photograph of your glans penis ?
4) Did you have unprotected sex preceding developing this rash ?
5) Do you have itching of genital?
The fungal infection of prostate is very rare and always accompanied by fulminating fungal infection of genitals with severe burning urination ,discharge from penis etc
1) .I do not think this to be fungal infection of prostate .It is very rare to get fungal infection of Prostate
2) Your urine culture report suggests highly sensitivity for Nitrofurantoin and sensitivity for Doxicycline has not been tested .
Terbinafine is an anti fungal infection and only works in case of proved fungal infection confirmed on laboratory findings .
I would comment on diagnosis and your treatment as under .
1) You do not seem to have fungal infection but a bacterial infection of Glans Penis Ballanitis which has complicated in to UTI as confirmed by urine culture .
This is perhaps the main reason for not getting any symptomatic or clinical response from anti fungal medication .
2) You have severe form of infection of glans penis (Ballanitis) with UTI which is confirmed on urine culture .
I would suggest you to consult qualified Urologist and get following test done to help more precisely to confirm the diagnosis
1) swab Test and culture of a secretion from the glans penis.
2) Test to rule out HSV 1&2 infection .
Till then I would suggest you to take following treatment .
1) Stop anti fungal medications (Mycolong and Terbinafine )
2) Take Nitrofurantoin and Bactrim D.S twice daily as reported in culture report
3) Use topical antibiotic ointment (Neosporin) twice daily
4) Wash and clean your genitals with warm water twice daily
5) Avoid sexual encounters till it gets cured completely .
Hope I have answered your query ,please feel free to ask if you have more questions , I shall be happy to help you .
Thanks and Regards.
Dr.Patil.
Thank you very much for your reply. To answer your questions
1) Are you diabetic ? - I AM NOT DIABETIC. DOCTOR TESTED FOR DIABETES.
2) Was a swab test of a white material or secretions from glans penis done to confirm diagnosis of Genital Candidiasis ? SWAB WAS NOT TAKEN, ONLY VISUAL BOTH IN XXXXXXX AND IN THE US.
3) is it possible to upload photograph of your glans penis ? ATTACHED PHOTO
4) Did you have unprotected sex preceding developing this rash ? NO
5) Do you have itching of genital? NO
As far as your recommendation, as soon as I stop applying the mycolog II, my foreskin starts sticking to the head. I need to peel it back.. it is not painfull but sticks.
Nitrofurantoin and Bactrim D.S are prescription drugs, I will need to talk to my GP or wwait for urologist appointment which is 2 weeks from now.
Neosporin is antibitic cream, if I indeed have candidiasis wont this aggrevate the issue?
That is one of my concerns that if I do have fungal infection taking all the antibiotics will only worsen it. won't it?
I dot think that you have fungal infection .
Detailed Answer:
hello
Thanks for follow up and uploading photographs .
My rational behind it to diagnose being bacterial infection and not fungal infection are based on following facts .
1) Photographs that you have uploaded
2)In absence of any positive evidence of you having fungal infection ,I think it is a presumptive diagnosis without any proof .Had it been a fungal infection it should have shown some clinical and symptomatic improvement after taking medications for almost three weeks ..
3) Where as there is proof of you having bacterial infection by urine culture .
You need to get prescriptions from your family Physician .
Thanks and Regards.
Dr.Patil.
Also he tested me for chlamydia and gonorrhea which are negative. Should i test these again? I have not had any unprotected sex.
I am really helpless
Detailed Answer:
Hello
Thanks for follow up .
You can discuss my points against the diagnosis of fungal infection with your G.P and request him to issue prescriptions for antibiotics which I have suggested as per culture report .
There is no point in continuing Doxicycline which has failed to give any results even after taking it for 3 weeks .
Thanks and Regards.
Dr.Patil.
O.K
Detailed Answer:
Helo
Thanks for follow up .
Please do write if you need my help I shall be happy to help you .
Thanks and Regards.
Dr.Patil.