Red/Purple 'burn' up head of penis

Hi Dr. Rockoff-

My problem is very similar to a number of your past postings but with a few differences.

At the end of May, I started to have some trouble with urination and my doctor, thinking it might be prostatitus, prescribed Bactrim. I began to take it and then noticed a bright purple "streak" that ran from below the opening in my penus head up one side of the penis head. It became more and more painful, like a "burning" sensation and finally was burning when I urinated. It seemed to escalate in severity rather quickly. I stopped the Bactrim.

I went back the doctor, who told me she thought it looked like a fungal infection (like yeast). She precribed 2 100 mg tabs of Diflucan. This seemed to take away the burning. I was also given a topical cream called Mentax and applied it as well. The skin on my penis head became more purple for a short while, then "grew" back pink and normal. Everything looked fine. Keep in mind I had no "Classic" yeast infection signs like discharge.

A few weeks went by and, noticing what seemed to be a reoccurance of my urinary symptoms, tried the Bactrim again. Guess what - duh - same reaction. More Diflucan this time, and Ketaconozole 2% cream was prescribed. This time the infection never really "went away". It got a lot better, but never disappeared. I have taken more Diflucan since... 100 mg for 10 days... to no avail. Finally, I took a short course of Flagyl, which also seemed to affect no change, but I may not have been on it long enough. It stirred my GI tract up pretty badly.

Here's where I am at now:
--- I have a redness around the slit in my penis. There is slight to moderate pain on one side or other of my penis virtually all the time. The discoloration goes from small pink area to big botchy purple. It is not generally painful when urinating.
--- Sometimes, like in the morning, when I have not urinated for several hours, the penis head looks fine. It appears to get red and irritated after urine or semen is passed, or even when I have a bowel movememt.
--- I can sit in a hot bath and the irritation will appear to "disappear" for awhile, or at least go down.
--- I have seen a urologist (but not a dermatologist) and they cannot seem to see anything overtly wrong with it. Keep in mind it can appear worse or better at different times of the day. I have a derm. appt scheduled this Friday.
--- Another hunch for a trigger theory on this problem in addition to the Bactrim: I reused a condom immediately after first use in May.
--- More info: I have a small dark brown "scar" below the penal head side most affected. I have had this scar for over a decade.

Is this bacterial, yeast, fungus, or just an irritation that won't clear up? I have tried doing nothing, putting aloe and Vaseline on. It's tough to keep it free of all irritants, and completely abstain from any form of sex. BTW, I am monogamous, use condoms with my wife, so this is not an STD.
I am in the Boston area.
Thanks,
bbear

[Alan Rockoff, MD]

I feel you have some mild irritation changes, that's all.  You are also examining your penis more than necessary.  Your description does not match that of yeast or bacteria.  I can't explain why Bactrim seemed to cause a problem, but I don't see why you need Bactrim.

The dermatologist ought to be able to set you straight.  I see no need for you to abstain from sex.  Proper diagnosis and mild treatment should take care of things.

Best.

Dr. Rockoff