My symptoms started about a month ago with a red/swollen meatus. Then I began to notice redness of the foreskin, occasional red blotches on the penis head (very temporary), and skin flaking away (moist under the foreskin, dry on the outside). I would get occasional irritation in my urethra, not really pain, more of a pinch.
On nights when I was aroused during sleep (sweet dreams :) I would notice the foreskin worse the next day. This would also happen if I masturbated and didn't practice good hygiene.
My GP said it was yeast/fungal and gave me 150mg of fluconazole and some cream and said it would clear up in a week. It's been a week and my symptoms improved but have not gone away. The red/swollen meatus is still there and there is still a little redness in my foreskin (the part is located near the opening when folded over when flacid).
Basically the consistent symptoms are the meatus/urethra, while the skin problems seem intermittent as they respond to cream.
I'm concerned the problem is coming from the inside, and that I'm just spinning my wheels keeping the skin from getting infected on the outside. Can this be a fungal infection of the urethra that causes skin irritation when exposed to internal fluids? If so, should the fluconazole dosage be higher?
I can appreciate your concerns since you have not found relief after a week of treatment. To discuss broadly, your symptoms of a swollen meatus with redness and skin chaffing can be due to meatitis or infection/inflammation of meatus, urethritis or infection/inflammation of urethra or due to balanoposthitis (inflammation of glans penis and foreskin).
In all cases the cause can be either a STD or a non-STD infection. If you have been sexually active, then it is important to test for STDs, bacterial vaginosis and fungal infection. Non-STD infections can be either bacterial or fungal.
Emperically (or without testing), usually a combination of antifungal and antibacterial cream is tried. This usually involves metronidazole with either of these antifungals: Clotrimazole 1%, Miconazole nitrate 2%, Tolnaftate 1% and Butenafine hydrochloride 1%. Orally fluconazole (150mg once a week) is effective. Since, you have achieved some relief with anti-fungals, you can apply this combination for another week and see. You can also take an oral non-steroidal anti-inflammatory such as Tylenol, Aleve or Mobic. Usually for most fungal infection the fluconazole dose would need to be taken twice a week for 2-3 weeks. However, please ask your doctor before stepping up the dose.
If you plan to test for the cause, it is best to avoid using any anti-fungal r antibacterial for at least 72 hours. You can give a swab test and a urine test after this.
Chaffing of skin and spread of infection to penis body and foreskin can be due to the organ rubbing against clothes, or due to frictional injury caused by masturbation, sex etc. Hence, you will need to take care regarding all three possibilities. It would be best to avoid sex totally, refrain from masturbating too often and wear loose clothes until the symptoms subside.
Please discuss all this with your doctor. Hope you get well soon! Good Luck and take care!
Thanks. I've been tested by urine and cotton swab (urethral). Everything came back negative except the culture test indicated there was a high level of normal bacteria. There is no more skin irritation, just an inflamed meatus. Does this change your assessment?
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