frenulum inflamed

I had a case of balanitis almost a year ago, to the point of having immune symptoms like lymph node tenderness and aches in my groin muscles and lower back (like the flu but on the bottom half of my body). It happened a week or two after having a condom break with a new partner, but it was also preceeded by a long course of tetracycline for an unrelated problem. There seemed to be yeast (whitish buildup) but I don't know if that's all there was to it.

The major symptoms resolved quickly but I was left with a mild epididymitis in one side. Also, and more noticeably, there is a burning/swelling seeming to come from the cord leading to that same testicle, where it runs over the pubic bone.

At this point even the swelling had become almost unnoticeable, but I still have a dark redness which is only in the frenulum.

I have asked a dermatologist and two urologists about it but haven't really gotten it resolved. Of the three, only one of the urologists even gave me a diagnosis and treatment. He believed it was epididymitis (and I agree, although the ultrasound was unremarkable -- maybe it was too mild) and thought the redness was due to some kind of indirect inflammatory response.

Is this believable -- that infection on the opposite end of the plumbing could cause a short section of the frenulum to become inflamed?

Unfortunately, 3 weeks of Levaquin followed by 2 months of Bactrim-DS didn't really do much. I had also been on Biaxin at one point. The epididymitis seemed unaffected but has receeded at its own pace since stopping those abx. But the redness has not changed at all and there is sometimes a slight burning during urination.

Earlier, my GP had prescribed me Mycolog-II cream for this but it didn't help. OTC antifungals didn't either.

I tested negative for Chlamydia and Ghonorrhea via urine PCR, and negative for a list of common STD's by blood test. I would not trust the test, except that presumably any one of those abx could have knocked these critters out. Mostly I am concerned about the tip redness and that it might be a transmissible bug.

Is it safe to assume that all those abx rule out a bacterial infection? What else could it be? A parasite? I am on day 3 of Diflucan to no effect so far.

Thanks...

[Kevin Pho, MD]

You have had a pretty comprehensive evaluation, including 3 separate physicians, an extended course of antibiotics as well as antifungal medications.  It would be tough to add to this without seeng the lesion.

You have noted that STDs have been tested for and negative.  A digital rectal exam to evaluate for prostatitis can be considered at this point.  A transrectal ultrasound can be considered for more thorough imaging of the prostate.

If everything is negative, you can consider dermatitis which can be treated with a steroid cream.  

Another dermatology opinion can be considered as well.  

Followup with your personal physician is essential.

This answer is not intended as and does not substitute for medical advice - the information presented is for patient education only. Please see your personal physician for further evaluation of your individual case.

Kevin, M.D.
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