jock itch: is non-visual confirmation necessary?

[c84M]

I'm not sure what else I have, but I definitely have a fungal / yeast infection, which started from my balls.  I link it to having protected sex with a girl who seemingly had a similar condition / symptoms, and perhaps to my long showers, and not using the towel to dry the area too well, and perhaps to my diet that was apparently very full of yeast (too much bread etc).  I don't have any flaking, however, just redness, and since I've started clotrimazole, and then hydrocortizone+clotrimazole treatment, if I miss it for even a day (together with missing a shower), the condition noticeable gets much worse (skin is really-really red, nearly bleeding (but not), and it totally improves after a shower with treatment).

It finally got somewhat better a few days ago, the skin on the balls at times looked completely normal and not red, but since I've decided to switch to the oral tablets, I stopped the topical treatment of 2.5% hydrocotrizone + 1% clotrimazole (I actually ran out of it).  From two days of Lamisil, my urine is no longer cloudy as it used to be, but it seems like today the redness moved to my legs near the balls, and I think it's again getting worse.  Should I go back to the topical treatment, or is there a way to try having someone confirm which kind of fungi do I have before resuming the topical treatment?  I've repeatedly asked the doctors to do the fungal tests, but they say there's nothing they can scrape! And that since I've been treating it, the test won't be reactive anyways.

My questions are:

Do these fungal tests tell you the specific family of the fungus?  Such that it'll be clear which drugs would be more appropriate?  Or does it simply confirm that there's some fungus?  Please advise.  I'd really like to know for sure, but so far it has been rather pointless to be missing the treatment, since noone is interested in doing any tests anyways...  I'm in Canada, and stuff seems to be different here from the US.

Also, would it be fine to use Nizoral shampoo to wash the area during the shower?

[c84M]

I got some Nizoral 2% shampoo last Friday, and some Head & Shoulders.  During the shower, I've been applying it to my genitals and my balls, and rinsing it off after a few minutes, sometimes repeating the procedure.

About two or three days ago, I've also (stupidly enough) masturbated with Nizoral and/or H&S for a few minutes in the shower.  After one day from that, a bit more of the redness has disappeared, but I started experiencing very slight pain during urination.  One day after that, yesterday, the pain from urination increased, and today it's really hurtful to urinate unless I try to control myself and not give it the full blast, especially during the beginning of the procedure.  It doesn't hurt to urinate if I do it during the shower, though...  Currently, it seems that the skin is _terribly_ inflexible and dry (trust me, I'm very reserved, and I'm not overstating this, the skin doesn't feel normal at all), and it's also somewhat oversized (previously during my fungal battle, it was undersized some time after the clotrimazole / hydrocortizone cream and/or masturbation with oil lotions / regular shampoos).

Please help, I don't know what to do to reverse the effects of Nizoral / H&S!  The penile skin is just too dry and inflexible after my unfortunate therapy with Nizoral.  I went to the walk-in doctor, but she wasn't interested in my problems, and didn't even examine my penile skin except for a very brief look.

[c84M]

I'm already using the topical antifungal creams, but I'm not sure just how much they are helping. :-(

I think it gets worse when I stop using them, but using them doesn't seem to get it much better... :-/

[Bhupinder Kaur, MD]

Hello,
Since you have a dermatologist’s appointment by the end of March, so you can request your dermatologist and get prescribed topical antifungals. Most cases of fungal infections respond to over-the-counter products, which contain any of several basic ingredients: miconazole, tolnaftate, terbinafine,ketaconazole and clotrimazole. You can consult a pharmacist and get any cream or lotion containing these ingredients.  

I hope it helps. Take care and regards.

[c84M]

> I suggest you to consult a dermatologist and get a KOH examination and fungal culture of the skin scrapings done to confirm the diagnosis.

I'm in Canada, and my dermotologist appointment is at the end of March, so that is a very long time away from now.

I've repeatedly tried asking my GPs to do the fungal scrapings, but they insist that there is no peeling skin to scrape from -- just the redness.  Is there any way I could convince them to do something?

[Bhupinder Kaur, MD]

Hello,
From the symptoms it looks like a fungal infection only. Wash your groin not very frequently and then dry thoroughly by pat drying, not rubbing. A hairdryer is useful if you have hairy groins. The damp groin is an ideal site for fungi to multiply. Also wear cotton underwear and change them twice a day. and do not share other people’s towels.Application of local antifungal cream(terbinafine, clotrimazole, econazole, ketoconazole, miconazole) and oral antifungal drugs are the mainstay of treatment.

I suggest you to consult a dermatologist and get a KOH examination and fungal culture of the skin scrapings done to confirm the diagnosis.

It is very difficult to precisely confirm a diagnosis without examination and investigations and the answer is based on the medical information provided. For exact diagnosis, you are requested to consult your doctor. I sincerely hope that helps. Take care and please do keep me posted on how you are doing.