Jock Itch? Eczema? Should I be worried?

Hello, Dr.  

I apologize for the graphic content, but I am bisexual and about a month ago I received unprotected oral sex from another male with a course goatee and he was rough on my inner thighs.

About a day later I noticed some mild itching in my inner thigh, and when I looked at it I noticed that there was a red, non-scaly rash on both sides.  It was worse on the left side than the right.  I figured it may have been a fungal infection so I got some Lotrimin cream and that kept it at bay for about 2 weeks.  Unfortunately, when the Lotrimin ran out the rash came back.

I then took a trip to my GP who diagnosed it as mild jock itch and prescribed a Nystatin Triamcinolone Acetonide ointment.  I asked him if the rash was just a coincidence with the oral sex and he assured me that it wasn't anything to worry about.

I have been on the Nystatin for about 2 weeks now.  It keeps the rash at bay, and for all practical purposes it doesn't itch.  As of now, the right side is very slowly getting better from what I can tell, but the left side seems to be the same.  Also, the redness goes down on both sides after I have cleaned the area in the shower, and they are better mid-day after the ointment has been on the skin for a few hours.  But, it seems like I reset to square one and the redness comes back when I wake up in the morning and repeat the process the next day . . .

It's not very itchy and it's not interfering with my life.  Truth be told, had it not occurred after the oral sex I wouldn't even be very worried about it.  I just want to know if I should be worried.

So, my questions:

1.  Do you think it's jock itch?  Eczema?  Something else?

2.  Is there anything I can add to my treatment regiment?

3.  Is this connected to the oral sex?  From the roughness on my inner thighs?

4.  Causes like HIV aren't even a plausible concern, right?

5.  Should I see a dermatologist or go back to my GP?

6.  Should I be worried?

Thank you, Dr.  I look forward to your reply.

[Jasmina Jankicevic, MD, MSc, CCRP]

I like the fact that you bullet-pointed your questions and concerns. I will do the same with my answers:

1. It sounds like intertrigo caused by abrasion.

2. Damaged skin of inner thighs is quite susceptible to infection (area is moist, unexposed to open air, exposed to chafing). To prevent that, keep area clean and dry (wash with water and mild soap twice a day and dry thoroughly). Friction, sweat, and underwear/clothes made of synthetic materials aggravate it. To support skin barrier function recovery, it is recommended to apply zinc oxide cream.

3. Short beard is a potential mechanical skin abrasive (if repeatedly and/or vigorously  rubbed against skin).

4. You wrote that skin lesions appeared day after unprotected oral sex. That could not have been a manifestation of HIV infection. I am sure you know that, so stop worrying. Furthermore, practicing safe sex can save you from being worried in future.

5. If skin lesions do not subside, even with enhanced treatment steps, in next seven days, evaluation by a dermatologist is recommended.

6. Not at all.


Yours in Optimal Helath,
Dr. Jasmina Jankicevic

[GettingBetter2010]

Thank you so much, Dr.!  

I really appreciate you taking the time to help me out.  I feel much better and am very glad to know that I have no reason to be worried.  I do have one more question, though.  Just for the sake of my own education, what is the difference between Intertrigo and something like Jock Itch or Eczema?  They seem to be different ailments with very similar symptoms.

Thank you so much for your time and help!

[GettingBetter2010]

Hi, Dr.

Sorry to bother you again.  I just wanted to clarify something with you.  You mentioned that acute HIV is out of the question due to the short manifestation of symptoms.  That makes perfect sense.

For my own peace of mind, it's pretty much ridiculous of me to think that this could be advanced HIV beyond primary infection, right?  I've only ever had oral sex / mutual masturbation within the last 2 years.  That aside, 2 years is far too soon for advanced HIV, correct?

Thank you so much for your help!