Red spots on foreskin under glan

[concerned000]

I'm 35 and recently (about a week ago) had red spots appear on the foreskin along the sides of my penis under the glan.  Three spots first appeared and then a fourth a few days later.  One spot on the left side has become less red, but the other 3 remain.  These spots do not hurt or itch, are only slightly raised, and do not have a head or blister. I don't feel any burning when I urinate, but sometimes I think I feel some faint irritation generally (but I think I'm focusing too much on my penis and imagining it).  It's been about 4 weeks since I last had unprotected sex with a woman that I see occasionally and who I know does not have STDs.  Before that I had sex with a woman (about 10 weeks ago), and while we were doing foreplay my penis briefly slipped inside her (for about 3-5 seconds).    I then pulled back out and put a condom on and immediately after sex I showered.  And I do not know her STD status.  I've never had these kinds of spots before, and I was last tested for STDs about 2 years ago, which came back negative.  I have an appt with my GP in about 3 weeks, but would appreciate some advice now.  I can upload a photo if that would help.  Thanks!

[Vanessa Lacuesta]

Hi,

This sounds like balanitis. "Balanitis is not sexually transmitted. It results from an overgrowth of organisms which are normally present on the skin of the glans. The condition most commonly occurs in men who have a foreskin (i.e. have not been circumcised). The environment under the foreskin is warm and moist, and these conditions often favour the growth of the organisms that cause balanitis."

Source:http://www.stdservices.on.net/std/balanitis/facts.htm

Balanitis may be due to fungal and bacterial infections. Sexual activity may cause some cuts and nicks on the penile skin which may initiate colonization and infection of bacteria and other organisms.

Refrain from sexual activity for a while. Observe the condition and see if it resolves. If the skin condition worsens then you may need further assessment for this. A fungal infection and dermatitis may present with redness and itchiness. Do not apply any creams or lotions in the area until you have been assessed by a physician. This may only cause further irritation.

You may check the above url for further information.

[concerned000]

Thanks, Dr.  I have now read a few websites discussing balanitis.  Many of the sites say that the condition is most common in uncircumcised men with poor hygiene.  I am actually very clean.  I also read that it can be brought on my chemicals such as soaps.  In fact, I recently switched to a new body wash--I have been using the same soap and body wash for more than a year.  I noticed these red spots right around the same time I started using this new body wash.  I haven't used that wash for a couple of days, and I will continue to refrain from using it and see if the spots go away.  Thanks again!

[Vanessa Lacuesta]

Hi,

You are welcome. Do continue to observe your symptoms. Avoid applying any medications on the area for the moment. We do not want to further irritate the skin.
Just continue good genital hygiene and avoid any sexual activity for the moment until the spots resolve .If the spots or skin condition persists then it is best to have this assessed by a physician.

[concerned000]

Hi Doctor.  I just wanted to give you an update on some minor new developments.  The 4 red spots/bumps I initially spoke of are still there but have not changed much.  However, they are not as red as in the beginning and no new red bumps have appeared.  Now my foreskin has a general red irritation but does not really bother me in terms of pain or itching (basically just red).  In addition, I now have some flesh-colored bumps on my shaft along the sides.  The scrotum also shows signs of these bumps and general redness.  But none of these bumps cause me any pain or itching.  Is this the dermatitis that you said might appear?

As for treatment, I have just been keeping the area clean, washing 2 or 3 times a day using water and/or mild soap.  I also keep the area exposed to air as much as possible.  For example, I sleep without underwear and keep the foreskin retracted at night.  

Please advise if you think there is anything I should be doing differently.  And I'm still scheduled to see my general physician in 2 weeks.  Thank you.

[Vanessa Lacuesta]

Hi.

Thanks for the update.

You have mentioned of new skin colored bumps on the penile shaft. How would you describe these bumps? Are they roundish or do they have a stalk? Are they flat bumps? Do they have a shiny or rough surface? Do they have a depressed or umbilicated center?

Maintain good genital hygiene. At this point, dermatitis does not appear to be the primary differential. Dermatitis should present with redness and itchiness, which does not seem to be your primary symptoms. I have been thinking of balanitis considering this is fairly common. Balanitis is still a differential here if the rash continues to involve the penile head (area under the foreskin).

Let us wait for your physician consult. Observe the new skin colored bumps. Refrain from touching the area unnecessarily and practice frequent hand washing. Use only mild cleansers to avoid irritation.

[concerned000]

Hi.  Thanks for the quick reply.

These new bumps are round and small but not flat.  The are not shiny or rough, and do not have an umbilicated center.  They are primarily toward the base of the shaft and extend up--but do not extend all the way up to the foreskin or glans.  

These bumps are not always obvious or apparently visible.  Sometimes I can't even really see them.  However, I just got out of the shower after going for a run and I could see the flesh colored bumps clearly.  

It is also interesting that you mention touching the area unnecessarily because I would admit to doing that.  I would say that I inspect the area too much and I retract the skin too often to inspect the red bumps.  Often where I am pulling back on the skin is exactly where the flesh colored bumps are appearing.

Thanks.

[concerned000]

Also, one point of clarification--you stated in your last post about the red bumps involving the penile head.  Actually, the head is free of any bumps.  The bumps are on the underside of my foreskin below the head of the penis.

Thanks.

[concerned000]

Sorry for the multiple posts.  I also wanted to mention that the hair follicles at the base of my shaft and onto the scrotum also appear to be irritated (i.e., raised and bumpy).  And I have looked closely at the bumps on my shaft (mostly on the underside) and they are raised round and smooth (they just feel like bumpy skin).  There are many of them, and they seemed to have spread more after I went running tonight.

I think I will go ahead and visit my local STD Clinic this weekend and get examined and tested, so as to get some closure on this issue.  

Thanks.

[Vanessa Lacuesta]

Hi.

Thanks for clarifying. Yes, I mentioned the red bumps involving the head. If  this is the case, then balanitis will be a strong differential. However, at this point we can not rule out balanitis completely. Fungal infections and folliculitis may be considered here. As you begin to clarify your previous posts, the differentials also begin to change in terms of priority. Swollen hair follicles and bumpy or rough skin may suggest a folliculitis, a dermatitis and fungal infections. Also, what you have noted as skin colored bumps in the base of the penis may be skin tags. I do not think they are very significant.

Refrain from frequently touching the area and have this assessed by your dermatologist. It is best to have an initial consult done so that you may be given the right medications if indicated.

[concerned000]

Hi.  I saw a doctor today.  She said that the red spots and flesh colored bumps did not look like a significant problem and did not resemble any STD symptoms.  She said she was not certain what it was but thought it was likely a fungal infection