recurrent balanitis with conjunctivitis

[shane2812]

I have had significant and predictable trouble with recurrent balanitis.  I have had concurrent conjunctivitis every time.  The symptoms appear after my partner and I have been together anywhere from a few days to weeks, and subside about 2-4 weeks after we part.  (We have had a long distance relationship).  



Since I am atopic, most folks have looked at this as a flare of "eczema/atopic derm."  This hasn't seemed "right," because I have been atopic since childhood without any prior symptoms like this- I never pop allegra or even think about allergies normally.



This experience acts a little like an infection- comes on acutely, has a very clear constellation of symptoms that are either present or absent, and then goes away over time.  I decided to just treat the thing aggressively....started a prednisone taper at 40, doxepin, plus allegra and surprisingly it didn't really do all that much.  Interestingly, a CBC on two occasions showed no eosinophilia, basophilia.  In my gut, I think this may be more along the lines of STD/pathogen exposure.  Maybe I'm sensitized to the pathogen.  (I have early arthritis as well- left knee, and I have an HLA-B27 test pending.)  



I would appreciate your thoughts, and recommendations about how to get to the bottom of this- please.  It has been psychologically very hard on my relationship.  The idea that I am "allergic" to my partner has been devastating.  Could I be reacting to infection/colonization/exposure to some pathogen (Gardnerella, Strep, anaerobe, Candida, Ureaplasma, Mycoplasma, etc.) and if so, what should I do to get a clear diagnosis?



Thank you for your time,



Shane Bradley, MD

[H. Hunter Handsfield, M.D.]

I don't think I can help much.  As you already seem to understand, these symptoms raise the possibility of Reiter's syndrome.  For those who don't know, Reiter's is a form of reactive arthritis that develops in response to any of several triggering infections, including chlamydia; and often is accompanied by skin rashes, including a particular kind of balanitis, and sometimes conjunctivitis.  People who are HLA type B27 are particularly susceptible.  However, the acute and recurrent nature of your balanitis and conjunctivitis are atypical for Reiter's.



Otherwise this doesn't suggest any STD--and that the only expertise I offer on this forum.  Your symptoms do indeed seem to imply an allergic/hypersensitivity reaction, but I cannot speculate what you are reacting to; perhaps to one of the organisms you mention (although I have never heard of such a reaction to them), or conceivably to your partner's genital secretions--which, although rare, has been documented.



Sorry I can't help more.  It seems to me the best shot at clear answers may come from an allergist, but if I were you I also would consult with a rheumatologist (which you might have done, if HLA testing is in the works) and perhaps a dermatologist.



Best wishes--  HHH, MD