Abnormalities on Penis

[micky889]

Hi over the course of the last 2 years i've been having abnormalities occur on my penis. My last sexual encounter was 3 years ago (Dec 2010).

In Jan 2013 this occurred:

Images
http://s9.postimg.org/x0y17myhq/2013_01_19_21_15_30_673.jpg
http://s9.postimg.org/6c6a9kg0u/2013_01_15_19_50_50_801.jpg
http://s13.postimg.org/q3an7aj2e/2013_01_15_19_49_58_544.jpg

I had a HSV-PCR test done (which was negative), STD tests for everything including HSV - IgG blood test (negative for both hsv1 and hsv2) and bacterial swab test done.

The swab test came back with:

Specimen/Site: Genital Swab
Moderate gram positive cocci
Scant gram positive bacilli
Moderate gram negative bacilli
Culture: Heavy Growth of ORG 1: Streptococcus Milleri

So it was declared as a bacterial infection.

Then in late Dec 2013 the same thing occurred again but a little different:

Image
http://s28.postimg.org/8xt4kw5y5/2013_12_29_18_32_14_384.jpg

I again had a HSV-PCR test done (which was negative), STD blood tests for everything including HSV - IgG blood test (negative for both hsv1 and hsv2) and bacterial swab test done.

However the bacterial swab test came back negative which concerned me. I was told it could had been balanitis.

Both of these times - Jan 2013 and Dec 2013 were in the summer months here in Australia.

[micky889]

Thanks for your reply.

So for both April 2014 and Dec 2013 its likely balanoposthitis or a fungal infection from Balanitis?

Any advice on how to prevent this.
I have been keeping consistently clean with frequent washing (water no soaps) and drying before the most recent episode in April 2014. Could this flare up in April, be because of having a poor diet or high sugar levels?

Erythroplasia of Queyrat is interesting, i don't think its that because the symptoms have disappeared. But i should probably get tested for it if it happens again.

[Bhupinder Kaur, MD]

Hello,

Thanks for posting your query.

I can understand your concern for these symptoms and I have checked the photographs. It is very difficult to precisely confirm a diagnosis without examination and investigations but from the photographs the first possibility that comes to mind is of balanoposthitis.

It is an inflammation of the glans penis and foreskin and which can cause soreness, irritation, Subpreputial discharge, superficial ulcerations, redness of penis and rashes on the penis and foul smell discharge. It has to be differentiated from erythroplasia of Queyrat which typically presents with solitary or multiple nonhealing erythematous plaques on the glans penis. The symptoms of both these conditions are similar and you need to get investigations done to confirm the diagnosis.

First of all get KOH examination of the skin samples and fungal culture done. To rule out any erythroplasia, get a biopsy of the skin sample done from a dermatologist. Treatment will depend on the results of the test.

PCR tests are highly specific for HSV and if they are negative then chances of HSV infections are less. Other than that, S milleri has been recognized as normal flora of the human oral cavity and gastrointestinal tract but has the ability to cause abscesses and systemic infections. However the recent swab test has ruled out any bacterial infection. Hence most likely it is due to fungal infection due to balanitis.

Diabetes can make balanitis more likely, especially if the blood sugar is poorly controlled. But in your case, your sugar levels are borderline and this can be prediabetes. Pre diabetics are more to developing full blown diabetes in near future. This does not usually need drugs to be controlled and glucose levels can be brought under control with good exercise and diet control.

A diet that includes fruits, vegetables, fiber-containing foods, and low-fat milk is advised for the same.

Hope that this information helps and hope that you get better soon.

Wishing you good health.

[micky889]

Then in April 2014 i had a completely different thing occur on my penis. When i pulled back my foreskin i had red dots around the head of my penis. Not painful but quite disturbing (I had been keeping very clean and hygienic ever since the experience back in Jan 2014, I'm uncircumcised. So it couldn't be a bacterial infection)

It looked like this:

http://s27.postimg.org/anzo4fpmq/2014_03_29_12_17_06_579.jpg
http://s27.postimg.org/75no81oqq/2014_03_29_12_17_35_956.jpg
http://s27.postimg.org/v6pyvre6a/2014_03_29_12_17_47_660.jpg

Again I was tested again, this time just a PCR which came back negative. However i did have a test for my sugar levels and they came back high (i'm not yet diabetic - glucose level with fastening was 5.9 mmol/L). The doctor said it was possibly due to this but wasn't 100%.  

Would like to get a professional dermatologist opinion on this.