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The Rash and Urethritis that wont quit


I have emailed you in the past about this same problem.  

My history is that 9 days after unprotected sex with an ex girlfriend I developed urethritis and a bump, rash and irritation at the tip of my penis.

Initially, I was tested for all STD's.  The only positive result was from a HSV 1 test.  I had several Type 2 specifc tests done and both were negative for herpes and I also had a intra urethral swab for herpes, also negative. The HSV 1 results were for IGG antibodies and the doctor i was seeing (infectious disease) did not think that was my problem.  He did agree the rash and the bump were something to be concerned with and thought it could be an exotic chlamydia infection.  I was tested for Chlamydia, negative.

After many many months of this I decided to try anti depressants.
Although I have not obsessed about my condition it did bother me and i figured anything was possible.

After about 3 months on antidepressants I realized they were not helping with my rash and although it was a valent effort they did nothing to help with the rash or the discomfort it causes me.

Here is what I've experienced:

Burning everyday in the same area of the tip of my penis.  It swells slighty most days and burns after I pee.  Every time!
My urethritis although not bad sometimes causes sharp pains, right testicular pain and mild swelling.

My glans is always red, scaley looking, it has a dark (what looks like to me a scar)patch in the same place from the entrance of my penis about 3/4" since this developed.  This patch was not there before this started, I'm sure.

It burns!!  The skin is always somewhat vascular and maybe even swelled a little.  The opening of my penis has a bump on one side that gets bigger and smaller and very red sometimes.  It burns.

I have tried forgetting about this, but I believe that it would be gone by now if there wasnt some underlying cause.  I would even except if it was almost gone, but this gets worse some days and it makes me wonder what is going on.  Likewise, the dermatologist, infectious disease doctor and my urologist agree it is something but have admitted they are stumped.  The infectious disease doctor asked me to travel to a larger city to investigate it more.
Here is what i ask of you:

What can a dermatolgist do to check the rash and bump on my penis?  What will scraping or biopsies show??  Would you suggest this now after 10 months??

Do any conditions come to mind??  

Any steroid type creams have made this worse.

What do you suggest??

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242489 tn?1210500813
I don't know what this bump is, or even whether it has anything to do with your symptoms.  Some doctors describe a condition they call "scrotodynia<' analogous to "vulvodynia" in women.  In either sex, the condition results in chronic burning and sensitivity.  Creams don't help.  Antidepressants have a variable effect.  There is no current consensus on whether this is physical,psychological, or both.

However, there is consensus that this is not an STD, or anything organically serious.  Therefore, get another opinion about the bump if you need it, but even if you have to live with the burning for some indefinite period, you can be confident that it will go away in time.  That's what has happened with patients I've taken care of with similar complaints.


Dr. Rockoff
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