Metronidazole for scrotum, penis and groin fungal infection

Hi,

I recently got diagnosed by my family doctor with a fungal infection of the groin, scrotum and base of the penis. I was prescribed metronidazole cream to use twice a day for this. I have been washing and drying the area thoroughly before applying the cream. I have also been changing my underwear daily.

Unfortunately after 4 days of use the infection is getting worse and I am experiencing a burning sensation slightly. Overall it feels very uncomfortable.

The initial symptoms were red patches of dry skin on the base of penis, red dry cracked skin on testicles, scrotum and groin. It has been very itchy and the itchiness still persists, which is waking me up at night. I have been careful not to scratch the area. I suspect its a yeast infection or jock itch.

I have been careful to apply not too much metronidazole as I know it can cause burning, I also wash the area with a sensitive washing cream and careful when drying the area. So I know it can not be irritation.

My questions are:

1) Does this sound like jock itch or a yeast infection?
2) Is it worth continuing to use the metronidazole if the symptoms are getting worse (slight burning)?
3) I read online that metronidazole cream may not be effective for fungal infections, is this true?
4) What would you recommend I use for this, can I buy it in a drug store/pharmacy?
5) With proper treatment how long should it take to go?

Thanks for your time.

[Jasmina Jankicevic, MD, MSc, CCRP]

Here are my answers:

1) Yes, it could be Tinea cruris (jock itch), but differential diagnoses include yeast infection, psoriasis, or even contact dermatitis.

2) Prior to introducing therapy, diagnosis of fungal/yeast infection should be confirmed by taking skin scrapings (potassium hydroxide test) and ordering culture.

3) Metronidazole cream is not recommended topical therapy for fungal/yeast skin infection.

4) In cases like yours, it is recommended to discontinue any random therapy for 7-10 days, perform diagnostic tests, and prescribe treatment. For a mild case of diagnosed jock itch, using an over-the-counter antifungal cream could be sufficient. In addition, it is important to continue with washing and thoroughly drying affected areas, avoid sweating, wear well fitted underwear, and do not share personal items.  

5) About two weeks. Check if you have fungal infection on your feet (Athlete’s foot) and treat it simultaneously to prevent reoccurrences.


Yours in Optimal Health,
Dr. Jasmina Jankicevic