Pain/irritation/red blotchiness on penis

[kasper673]

Dear Doctor,

37 y/o circumcised male here. I was unsure whether to post this in the Derm or STD area but figd I'd start here.  Approximately 10 1/2 weeks ago I had unprotected sex with a woman.  About a week and a half after this encounter the penis glans and corona started to become very sensitive, irritated and slightly red. About a week after that the redness and irritation began to extend below the corona down to the circumcision scar and a sharp pain and ache developed on the glans.

I went to see my GP had an urinalysis, was tested for gono/chlamy with all negative results and was provided with a mild steroid ointment. I went for a follow-up visit at the 7 1/2 week mark and had a blood test for syph/hep/hiv with all results being negative. After these results it was suggested to see a urologist and/or dermatologist.  The urologist examined me and said things looked pretty normal just slightly irritated and suggested seeing the dermatologist.  

A few days later immediately after masturbating I noticed a tiny bright red spot appear just to the side of the urethra opening as well as a very small area of bright red blotchiness on the underside of the glans, this red spot and blotchiness slowly disappeared within hours. A week or so later the dermatologist examined me and told me to moisturize the glans as well as corona and provided ointment to try to reduce the redness of the skin below the corona. In a follow-up it was suggested to keep repeating the use of the moisturizer and ointment.

Currently the glans aches, the glans/corona are dry, slightly red as well as the skin directly below. Also yesterday while masturbating I noticed the red blotchiness appear all along the rim of the corona and in a small diff area on the glans, this disappeared within hours. Does this sound STD related or maybe a more of a dermatological condition?  All doctors visually ruled out herpies so I have yet to be tested for this.  Any input is greatly appreciated.

Thanks

[H. Hunter Handsfield, M.D.]

If you just have scant, comletely clear discharge, especially in the morning when you arise, it's probably not abnormal; we all get nocturnal erections, which are accompanied by pre-ejaculate fluid.  But if the discharge is cloudy or present in larger amount, get examined professionally.  Either way, herpes doesn't cause painless discharge.

I recommend against an HSV blood test.  Just scan this forum (search for herpes) to learn a lot about the imprecision of the test.  And if you have a positive result, it will not explain any of the symptoms you have described.  It would only mean you have an asymptomatic HSV infection plus some other cause for the symptoms.

[H. Hunter Handsfield, M.D.]

Thanks for the thanks.  You're welcome.  

[kasper673]

I almost forgot to say thanks much for the responses and all of the useful information. I'm currently following up with a dermatologist.

[kasper673]

I apologize for my late response as I've been out of town and thank you very much for your time, quick response and insights. I have made an appointment to follow up with another dermatologist for a second opinion. Yes I very much agree as I've been over analyzing myself as well as being stressed and anxiety ridden. I did forget to add that I seem to be occasionally getting a noticeable clear discharge, with the testing that I've had done would it be wise to assume that this shouldn't be of high concern or likely related as I don't believe a clear discharge is a male herpetic symptom?  I'm waiting for the 3 month point to get a Herpes test as well.

Thanks

[H. Hunter Handsfield, M.D.]

Welcome to the STD forum.  I'll try to help.  My initial response, based entirely on the title you chose for your question without reading anything else, is that I doubt you have an STD.  "Pain/irritation/red blotchiness on penis" doesn't sound typical for any STD, and any of the skin problems that cause rash anywhere on the body sometimes can affect the genitals.

Now I have read the rest. I nailed it -- and in a way, so did you, as reflected in your uncertainty about whether the question would be best on this or the dermatology forum.  In addition to the symptoms not being typical for any STD, the negative test results you have had are highly reliable in excluding STDs.

Sometimes when a person has a sexual encounter s/he regrets, s/he becomes more aware of genital symptoms or skin features that really are not new but seem so.  Since neither your urologist nor dermatologist can see anything clearly abnormal, I have to suspect that's what is going on here.  And it sounds like the redness and blotchiness are associated with sexual arousal, which is a time of markedly enhanced blood flow to the penis (that's part of the reason it goes erect), which can create red patches in entirely normal skin -- just areas with somewhat more dense capillary networks.  Or maybe there is indeed a superficial skin problem that shows up more prominently during the increased blood flow with arousal.  

These are just educated guesses -- a dermatologist is in a better position to judge whether I'm on the right track.  In any case, I really would not be at all worried about an STD as a cause of these symptoms.

Best wishes--  HHH, MD