Treated for everything, it seems

Doctor,
This one's a toughie.  It's been two months, and I've tried just about everything.  There is red and inflammation on the tip of my penis, surrounding the opening of the urethra, and redness going down the medial-ventral line of the penis head.  The skin is bright red (it was never formerly this color) and occasionally seems to be scaly.  It is markedly different in color than the rest of the penis head.  The shade of redness and differentiation from surrounding skin changes frequently.  A couple of times while out drinking alcohol, I have experienced a frisson (shudder) seeming to emanate from my penis/urethra.  I occasionally experience discomfort while urinating.

The condition first appeared about two months ago, two days after protected sex with my girlfriend.  After swimming for exercise, my urination was followed by a single drop of blood off of the tip of my penis.  I looked and discovered the aforementioned redness and swelling.  The blood was a one-time occurrence and has not been replicated since that time.  But the swelling at the tip and redness throughout remain.

I've seen a few doctors about this.  The internist urine tested me for gonorrhea and chlamydia, and swabbed me for herpes.  Then I was treated for all of the above (zithromax pills, an injection, possibly of ciprofloxacin, in the buttocks, and a 10 day cycle of acyclovir) before test results came back.  All tests returned negative.  None of the above medications affected any change in my condition.  

So I saw specialists.  The urologist said he didn't see anything wrong with me.  The dermatologist said that it looked like irritation, and prescribed mupirocin (an antibiotic ointment), which similarly had no impact on my condition.  A doctor at the STD clinic suggested that I could try treating the area with hydrocortisone.  I have tried that for the last several days, with no change whatsoever in my condition.  The STD clinic doctor also took a swab of the inside of my urethra which showed that there was no infection -- I assume that this means there is no local elevation in my white blood cell count.  

The theories are various: irritation due to clothing or washing soap, due to spermicide, due to my own shower soap, etc.  But I've changed the soap for my clothing, I didn't have sex for weeks thereafter (no contact with spermicide), and I've also changed my shower soap.  My condition remains the same.

So what are your thoughts?  Possibly a fungus?  Penile cancer?  What kind of doctor should I see next? I am truly at a loss, as are most doctors, it seems.

I am a fairly healthy 25 year old.  Some relevant history is as follows: once had molluscum contagiousum, and blood tests show that I have been exposed to HSV II, though I've never had any symptoms.  I am allergic to penicillin and derivatives thereof.  Will look forward to your reply.  

Thanks,
Argh

[H. Hunter Handsfield, M.D.]

Whatever is going on, it isn't an STD--which is my only area of expertise.  Given what your many doctors have told you, I have to assume nothing abnormal is present.

That you are infected with HSV-2 (if the right kind of test was done) is sort of intriguing, and herpes can be very atypical and has a highly variablee course--so although I very much doubt herpes explains your problem, somewhere along the line you might want to take one of the antiherpetic drugs (acyclovir, valacyclovir, famciclovir) for 7-10 days to see if it makes a difference.  But I doubt it will.

Whatever is there, if anything, you can obviously be 100% confident it isn't a serious or dangerous problem--nothing that will ever affect your health or that of any future sex partners.

Good luck--  HHH, MD

[Argh]

I did take a 10 day cycle of acyclovir, as mentioned in the section above.  Are there any patients with whom acyclovir is ineffective and other drugs (e.g. Valtrex) are helpful?

[JBrown]

I sympathise - see my post.  General soreness can really put a downer on your sex-life and marriage.