Spotty penis

[Alexalways]

I'm an uncircumcised male. In February I had unprotected sex outside my relationship. About two weeks later noticed two small red spots on the underside of my foreskin - they looked like a very small red pimple of the type you might get on your face. They faded to nothing in under 5 days, but over the next six weeks I saw a pattern of 2-5 spots appearing at once, fading, and then a couple of days later some more appearing. No itching/pain, no broken skin or ulceration. No discharge.  This cycle was roughly weekly.
I have tested negative for chlamydia, gonorrhea, HIV, syphilis, trichomonas. Negative PCR swab of spots for herpes and negative antibody test at 16 weeks for HSV I and II.

I got various advice over this time:
1. GUM Clinic - probably irritation, don't wash there with soap
2. Online Dr. - might be fungal, try clotrimazole/hydrocortisone cream
3. I tried 1g azithromycin taken with 150mg flucanazole
4. General Practitioner - might be candida balanitis, try a 7 day course of flucanazole plus Trimovate cream

Only option 4 seemed to work - I had spots that faded and I saw no more for over 6 weeks.  I went back to unprotected sex with my girlfriend as everything seemed fine - 4 days later, a new spot.

Another STI Dr. - No symptoms that day but he heard the history and said: "100% you have eczema on your penis - I see it daily, lots of Dr's treat for fungal infection. Trimovate worked because the steroid dealt with the inflammation. No need to treat for infection"

I held off any sex for two weeks, then had sex with my girlfriend.  24 hours later I saw a spotty rash covering the whole underside of my foreskin. Each spot looked the same as previous but rather than 3-4 there were too many to count. Some discomfort as skin felt dry
My girlfriend had self-diagnosed cystitis in April, but no other problems.

Does the eczema explanation sound convincing? Should I seek further testing or to get my girlfriend to treat herself for fungal infection?

[Edward W Hook, MD]

Please let us know what the dermatologist says.  EWH

[Alexalways]

Thanks very much for your input. It is certainly comforting that none of the medical professionals I have consulted differ in their view that it is not an STD.I think I will have to try and show the latest symptoms to a doctor in person as, although guilt is a large factor in my worry, my feeling is that the latest rash is far too obvious and different to 'normal' to just be a variation in the appearance of healthy skin. I too have thought about a dermatologist if it persists, and I will discuss this with my general practicioner.

[Edward W Hook, MD]

Thanks for the clarification. This is very helpful  You need to forget about STDs and get over your guilt related to your exposure in February.  These spots neither sound like an STD, nor have your tests or any of the doctors you've asked worried about them as possible STD.  Sometimes after an exposure that, in retrospect, one wishes they had not had, persons tend to examine themselves and be far more attuned to genital sensations than in periods when they are not concerned.  This in turn leads to noticing what turn out to be normal sensations that might have been not noticed or ignored at other times.  Remember,  the penis is a highly vascular organ and, as result, normal changes in blood flow can make normal structures appear as "bumps" or to be redder in color than is normal.  Perhaps this was a contributor to your situation.

Given your response to antifungal therapy, that is the only other possible infectious cause I would place as a reasonable possibility and the coming an going you describe is not typical of fungal infection.

Finally, if you feel you must see another health care provider, I would suggest a dermatologist.  Personally, I hope that my comments, along with what you've hear from others will relieve you of your concerns.

Take care.  EWH

[Alexalways]

Thank-you for a prompt response!

Yes, my main worry is that it relates to the exposure in February - I feel that they weren't there before and now I am plagued by them coming back every time I think I can put it all behind me! The discomfort is all mental, not physical. I am predominantly worried about transmitting something on, nothing at the moment is making me feel my own health is at a large risk. I could have lived with seeing occasional odd spots that the doctor told me were eczema - however the sudden rash over the whole area was too much to ignore.

You are right they come and go but do not persist. I have not seen them persist for longer than five days at the most - I had some trouble showing them to a doctor for this reason. They are always most prominent when I first notice them, then gradually fade back in to the surrounding skin.

Before the 6-week reprieve that I felt was brought about by the trimovate/flucanazole I did not associate the spots with sex. I was only having sex with a condom throughout the time when I was seeing them and they seemed to come without me being able to identify any trigger. It is only the last two weeks (the single spot and then the rash) that I have felt the only variable that changed was that I had sex without a condom in the days before noticing symptoms. I have not noticed the skin being aggravated at all by masturbation.

As with previous episodes, the rash is fading and many of the areas covered in smaller spots are already clear. I first saw it Thursday bedtime, I think it will be gone within 24-48 hours at the current rate of progress.

[Edward W Hook, MD]

Welcome to the Forum. similar to when you asked this question on the International Forum, I cannot diagnose your problem over the internet but I can offer some suggestions.  

Further, as I consider your problem, I sense that the main problem here is that you are aware of these spots and worried that they are relate to your exposure in February- is this correct.  It sounds like the spots do not persist but come and go an seem to be more likely to be noticed after sex.  Am I correct in this?  You answer will help me to make suggestions.  What you can be sure of at this time however is that this is not an STD an is not caused by anything you acquired during your exposure  in February- your tests prove this and STDs o not come and go in the pattern you describe.

I'll await your answer to my question.  EWH