skin infection of the buttocks? red scrotum syndrome? agh.

hey doc,

Hope you can help me. Two months ago I had unprotected sex; the day after my penis and scrotum were very red and sore, and the day after that I developed a burning sensation in my scrotum, which turned bright red. This sensation persisted for a few weeks, and it spread to my inner thigh area (which didn't turn red though). Also, a small rash developed at the very tip of my penis, and I remember one night it was impossible for me to urinate. Fortunately, the burning sensation eventually faded in my scrotum; however, it migrated to my buttocks, where I still get a burning sensation, especially after sitting down for a while. When I stand up after sitting down, there are red patches on my buttocks, which fade after I remain standing for a while.

I tested negative for all stds, including herpes (via herpeselect) at 6 weeks. The persistence of this sensation leads me to believe it is either some kind of fungus, yeast or bacterial skin infection. My urologist suggested it was a fungal infection; he prescribed me Nystatin, and then after three weeks Clotraminozole, which I have been using for a few weeks. These creams may have made the situation marginally better, but they certainly haven't healed me completely -- my butt still burns.

My current situation is a red, rough scrotum that itches slightly (but doesn't burn anymore), a small red rash around the tip of my penis (that is especially pronounced after I come out of the shower... a clue?), and a burning sensation on my buttocks (there is only a rash after I stand up after sitting down for a while, otherwise the skin looks dry and flaky but there is no rash). I am not sure this is linked to the sexual encounter either, since I remember having similarly vague symptoms before, although whatever it is, the sex definitely amplified it.

I'm 23 years old, circumsized, and I am fairly active in that I play basketball, run, etc. Also, I have not been with anyone for fear of transmitting whatever I have.

[Alan Rockoff, MD]

Your symptoms sound like mild eczema plus a lot of anxiety.  They do not sound like an STD.  They also do not sound like yeast, which is why I think nystatin, a yeast cream, didn't help.  Also, please keep in mind that after irritation, the groin skin can stay pink-red for weeks, even if the rash itself is gone.  My advice: use over-the-counter 1% hydrocortisone cream twice a day, moisturize liberally, minimize friction, and see a skin doctor so you can put this behind you.

Take care.

Dr. Rockoff