Dr. Dhepe Snehal Madhav
Venereology
The following is an actual conversation between an iCliniq user and a doctor that has been reviewed and published as a Premium Q&A.
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Patient's Query
Hi doctor,
I am a medical tourism advisor looking for advice for a 60-year-old male patient who has severe skin issues with the soft tissue of his glans penis area where some infection has developed in about the last 21 days. He has rashes and multiple red spots on the penis head and visible infection on the glans penis area only. No infection on the soft sliding part of the foreskin or any other aspect of the skin. No pain unless the foreskin is withdrawn or while water touches during the bath. There is no much irritation unless the area is touched or disturbed. Medicines applied are Lobate GM, which does not give much relief, Quadriderm, Canesten, and T- bact Mupirocin. The antibiotic taken ten days back is Augmentin 625 mg twice daily for five days.
Hi,
Welcome to icliniq.com.
Is he diabetic? Does he have any fungal or bacterial infection in the past? Does he have any history of psoriasis? Does he have any history of eczema? Does he any swelling or inflammation? Does he have any history of trauma or injuries? Did he scratch and rub the lesion? Does he have any joint pains? Does he have poor hygiene? Does he have excess sweating? Does he wear tight inners? Does he have any history of hyperkeratotic plaques with micaceous scaling? Use Fucidin (Fusidic acid) cream twice daily for seven days. Take Tablet Zifi (Cefixime and Clavulanate) 200 mg twice daily for five days and Tablet Fluconazole 150 mg once in a day for three days. Does he have any history of fever? Is he sexually active? Does he have any itching, burning, irritation, pain, or tingling sensation? Does he have any contact with an irritant or chemical? Is he allergic to latex or lubricant? Is he allergic to scented lotion or soap which he uses? Does he have any drug history or drug allergies in the past? Answer the questions for details and prevention measures. Please do reply.
Patient's Query
Hi doctor,
Thank you for your reply. I have no history of fever, but sometimes feel feverish for a short while. I am sexually active with my spouse. I have minor itching and burning when passing urine or when taking a bath. I have pain sometimes while taking a bath and applying medicine, but it is quite manageable. I do not have any tingling sensation. I regularly wash that area and very particular about hygiene, and use only clean cotton underclothes. In the past few months, I used medicines like Lobate or Quadriderm, Xylocaine, or Canesten and T- bact. I use a contraceptive, which is latex, and I am not allergic to it. I use soaps during bath and after intercourse. I am allergic to Sulpha drugs. And I have excess sweating. I do have a minor fungal and bacterial infection while traveling outside. I am not diabetic and have no history of psoriasis, eczema, swelling, or inflammation. I have mild joint pains and had a leg fracture last year.
Hi,
Welcome back to icliniq.com.
It is pseudoepitheliomatous keratotic and micaceous balanitis common in the elderly. Use Hydrocortisone 1% gel in the evening for five days (very little to reduce inflammation), Miconazole cream at night for 14 days, Fucidin (Fusidic acid) cream at daytime for seven days, take Tablet Fluconazole 150 mg once in a week for three weeks. Avoid using scented soap or harsh soap in that area. Use a non-soap mild cleanser like Episoft cleanser to clean the genitals. Pain on urination, irritation, inflammation, and redness are the symptoms of balanitis. Possible irritants like harsh soap, lubricant, and latex allergy can also cause it. To confirm the cause, a swab test is needed to check for the infection. Do Biopsy for confirmation of diagnosis. Do urine tests and blood tests to rule out the possible causes. Wash area with Episoft or non-soap cleanser. Dry the area after cleaning. Maintaining good personal hygiene helps prevent and treat this condition. The penis head should be washed carefully after retracting the foreskin. Avoid using scented or harsh soap on genitals, as mentioned previously. Wear loose, comfortable inners to keep genitals cool and dry. Avoid occlusion or friction. Infection can recur if blood sugar levels are not under control. High blood sugar level increases sugar levels in urine. When this urine containing sugar dribbles and stays on the glans penis, it becomes a friendly place for yeast and bacteria to feed and grow, which results in infection. If there is recurrent infection, the cause has to be identified and treated. Do all tests, as mentioned previously, with BSL (Biosafety level). Get all STI (sexually transmitted infection) panel tests done, including HIV (human immunodeficiency viruses). Follow-up for any doubts.
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