Balanitis or STD? Need some advice please

[jbrowz]

Hi,

I'm 30 year old male uncircumsized and since Feb 2010, I've  experienced redness on my penis glands with  no discharge from tip, no burning when urinating, but recently developed what i believe to be balanitis. When using a tissue to wipe the head of my gland, it appears that a dry discharge comes off the surface and is smelly. Some background information:

I visited the doctor at the end of March 2010, to do a complete STD check which involved PCR of Urine, and HIV, Syph,Hep1&2 blood tests and all was negative. So the doctor advised I should use some anti-fungal topical cream such as clotrimazole and apply it on the affected area. About two weeks later, Ive been searching on the web and read about false negative test results, so I went and got tested again. The tests came back negative again. I did a urinalysis and everything was ok too.

I've been applying the cream about 2-3 times per day, and while the cream is on, there is no itchiness and the redness  dies down, however as soon as I stop the cream or if it's been a while since applying, the symptoms come back. It's really bugging me. I'm going to take some diflucan as the next step...and also going to be getting another blood test next week for diabetes.. I've never had this problem before and it's stressing me out...

A few questions:
Would balanitis show up in the urinalysis?
If I tested negative twice for STDs, can I be assured this is not STD related?

Thank you

[Dr. Jose Gonzalez-Garcia, MD, MRCGP, PhD]

You might need to be re-tested if the symptoms have recurred, as well as starting possibly a different course of antibiotics.  I would advice you to discuss all of this with your doctor.
Best wishes,
Dr José

[jbrowz]

Hi Doc,

During the course, the symptoms of redness at tip, discomfort, and painful erection were not present.

It's been about a week since I had finished my course of the above antibiotics, but it appears the symptoms are creeping back slowly. Redness at the tip, and general feeling of hotness down there. I have a feeling that whatever it is hasn't gone away.

What are your recommendations and next steps?

[Dr. Jose Gonzalez-Garcia, MD, MRCGP, PhD]

Hello J.,
That positive result from the swab might explain the symptoms that you had.  Streptococcus milleri is a bacteria that can be present mainly in the mouth and in the gut, but also occassionally also as part of the urethral flora, where it can cause symptoms.  It is not generally considered a sexually transmitted disease and the antibiotics that you were given should clear it without any problems.  It can be contagious but most of the time one does not need to treat it unless it causes symptoms.
Best wishes,
Dr José

[jbrowz]

Hi Dr,

So I had a diabetes test which turned out negative. I also had a swab down in my urethra.

Swab results come back with a heavy growth of "streptococcus milleri".

I've been given a broad spectrum antibiotic cephalexin 500mg two tablets twice a day for 5 days, then one tablet every day for three weeks.

I'm hoping this cures this, but wondering how could I have got this? Is this a STD? Is this contagious?

Look forward to your response,

Thanks,
J

[Dr. Jose Gonzalez-Garcia, MD, MRCGP, PhD]

Hello,
Thank you very much for your post and welcome to our forum.
Your whole description fits perfectly with the diagnosis of balanitis.  Sometimes these infections cna be mixed infections with fungi and bacteria, and for this reason it might be worth having a swab of the area in question.  You might want to try a different cream called trimovate, as it contains both antifungals and antibacterials, but taking a single dose of fluconazole 150mg (Diflucan) is also a good idea.  Excluding diabetes is also very wise.
Best wishes,
Dr José