Redness/sensitivity around urethral opening

[Red]

I am a 38-year-old male. I have redness about ¼ inch wide surrounding the urethra opening. The discomfort is a combination of an itch/burn/stinging. It seems to extend up the urethra a short ways. I have been prescribed hydrocortisone by both an urologist and a dermatologist without success. While mostly mild, it does vary and of course it is a rather sensitive area to begin with. Intercourse can aggravate it but abstinence will not allow it to disappear. There is also a mild stinging while urinating.



I’ve had this for nearly two years – it began with a terrible burning while urinating or ejaculating. It was assumed I had prostatisis and was given a sulfur-based antibiotic for 3 weeks. This eliminated all of the problems while taking the antibiotic but the redness (rash?) came back within a day or two of finishing the prescription. A refill obtained one month later had the same effect – rash gone while on the medicine but it came back after finishing it. A new prescription (Cipro?) obtained yet another month later had little effect. And again with Septra.  In a later follow-up the urologist decided it must be a dermatology problem as no infection was detected in the “quickie” urine tests they do while in the office.  So I’ve gotten rid of most of the problem but am left with this as described at first.



Other weak evidence – the hydrocortisone seems to make the sensitivity worse after a few days use but the dermatologist said treatment was a long-term endeavor. Frankly I believe the source of the problem is upstream (ha!) inside of me – a mild but chronic infection in the bladder, prostate or urethra.  I really don’t think a topical ointment applied to the exterior will cure the problem.  Do you have any thoughts on what can be tried from a dermatologist’s perspective? Is this likely a localized site-specific fungus, as the urologist believes?

[Alan Rockoff, MD]

Red:



I believe what you have is indeed localized, or site-specific as you call it, but that it is not a fungus or infection.  Bacteria upstream in the bladder might cause frequency of urination but not sensitivity at the end of the stream only.  Also, this would get worse over time, or else go away and stay away, not come and go.



I think you have a ombined physical/psychological problem.  The orgonal inflammation left you with a reisdual sensitivity in an already sensitive area, as well as a predisposition to think about that part of the skin.  When men think they are losing their hair, they complain that the scalp burns.  Other examples, in my experience, are legion.  



The first task is to eliminate a tretabale condition, such as an infection.  You have done this.  The next step is to convince yourself that this has indeed been done.  If you're not convinced, get asd many opinions as it takes to do so.  Then stop the hydrocortsione, stop all treatments, stop thinking about the area, and just get on with things.



If you follow this course, you may well find that the symptoms will gradually extinguish themselves over a period of weeks.  Try it.  What have you got to lose?



Good luck.



Dr. Rockoff

[George]

Maybe a mild herpes infection?