Q. Red rash on the glans keeps coming back after sex or masturbation. Please help.

Answered by
Dr. Kakkar
and medically reviewed by iCliniq medical review team.
Published on Jul 25, 2018 and last reviewed on: Aug 07, 2019

Hi doctor,

Over the past three months, I have been experiencing some penis problem. I have a consistent red rash on the front of my penis glans that can go away and come back daily. After sex or masturbation, the rash will get brighter and red, unraised dots (not itchy) will appear all over my glans and foreskin. They will usually disappear on their own within three to four days. My penis glans are also very dry and have a wrinkled look to it, and the foreskin can stick to the penis glans and have a 'bandaid' effect when retracting the foreskin down. However, by applying Vaseline twice a day I have noticed the dryness to subside, although the red rash will typically remain.

I have been tested for STD's and have had a yeast swab test all come back negative. The doctor ruled out herpes by looking at it and said it was mild balanitis (inflammation of the glans). However, I have been washing with just warm water daily (ruling out any allergic reactions to soap) and keeping the area dry. This is more an esthetic issue than functional and it is ruining my confidence with my girlfriend. Why do I always get balanitis after sex or masturbation? The symptoms seem like yeast, but my swab test was negative. Please help.

Dr. Kakkar

Dermatology HIV/AIDS Specialist Venereology
#

Hello,

Welcome to icliniq.com.

I have noted your concern.

On and off rash suggest that it is some sort of a skin condition like a noninfective balanitis, if not a yeast infection. Moreover, the swab test may sometimes reveal the yeast on a repeat test so that can be considered along with a fungal culture.

I also request you to kindly upload an image of the affected area so that I am able to guide you better. Regards.

For more information consult a dermatologist online -->https://www.icliniq.com/ask-a-doctor-online/dermatologist

Thank you doctor,

Please note that the red rash in these photos is not as noticeable today. However, the red dots are visible. These dots appeared two days ago and are slowly disappearing. Again these dots do not itch or provide any discomfort.

Dr. Kakkar

Dermatology HIV/AIDS Specialist Venereology
#

Hello,

Welcome to icliniq.com.

Clinically, it does look like a yeast infection (attachment removed to protect patient identity) with red spots and moist/ macerated papules. I suggest you try a topical antifungal, for example, Clotrimazole 1 % cream, twice daily for a week. In addition, I also suggest you take an oral antifungal tablet like Fluconazole 150 mg, single dose.

Does your girlfriend complain of vaginal discharge? Itching?

Do you use a condom? Another possibility is that it could be a minor allergic reaction to latex in a condom although it looks more like a yeast infection. Regards.

For more information consult a dermatologist online -->https://www.icliniq.com/ask-a-doctor-online/dermatologist

Sorry Dr, its been a while since we last spoke about my case. However, I am still getting balanitis on my glans to this day. To answer your questions, no my girlfriend does not complain of any vaginal symptoms at all and we do not use a condom. We have been tested and are clean so I do not know why I get balanitis after any type of friction.
I also applied the recommended "clotrimazole 1 %cream, twice daily for 2 weeks and oral antifungal tab fluconazole 150mg, single dose". This didn't really seem to do anything. (At times it made my glans have a cracked look and became more red)

However, I have noticed an unusual trend.. my penis glans has been better over the last month. What I have been doing is washing my penis as soon as possible after sex, then applying a hair dryer for 1-2 minutes on low setting onto the glans to dry it. This has seemed to stop the small red balanitis dots from re-appearing. The redness still remains but only very slightly. As an experiment I stopped hair drying my glans after I had sex...surprise... one small red dot appears then my whole glans is covered in them. What is going on Dr? I don't want to hair dry my glans for the rest of my life.

See attatched different outbreaks over the recent weeks. At times a single dot will appear followed by multiple dots.

Dr. Kakkar

Dermatology HIV/AIDS Specialist Venereology
# Thank you.
Perhaps it is just a simple skin irritation from the act of sex / masturbation. I suggest you to use a topical steroid e.g cortisone cream (1%hydrocortisone), twice daily for a week. You can try to practice safe sex with a condom.
I have used a steroid cream before,
It created extreme thinning of the foreskin. It helped for a week but I had to stop due to extreme thinning.
Don’t you find it odd that as soon as I stopped the hair dryer treatment I was more prone to balanitis?

Dr. Kakkar

Dermatology HIV/AIDS Specialist Venereology
# First of all, you should not worry too much about this because your screening tests for STD are negative. Moreover, culture for yeast is negative. Also you have been treared with both oral & topical antifungals.

Rarely, certain bacteria may also cause inflammation of glans. The moist and warm undersurface of prepuce provides an ideal environment for the bacteria to proliferate.

I suggest you to try a topical antibacterial e.g either Neosporin ointment or Mupirocin 2% ointment, twice daily for a week.
Okay I’ll give that a try.
I also sometimes feel an inner soreness that comes from within the penis, almost like the urethra feels sore. It doesn’t hurt, just feels sore. Along with this I will sometimes get a throbbing/ pulsating sensation in the Perinium area. Is this all linked?

Dr. Kakkar

Dermatology HIV/AIDS Specialist Venereology
# Ok. Just wanted to confirm whether you were also screened for herpes simplex virus (HSV). What was the nature of test for HSV? Was it a blood test?

Was going through your previous query. You were facing this issue for 3 months when you first wrote to me.

HSV Elisa, IgG is considered conclusive at 12-16 weeks from infection

So, if your STD testing was properly timed i.e a 12 week intervening period from the time of infection or when you first noticed these spots than it is reliable, otherwise I suggest a retest to include that minimum window period before HSV testing
I am not sure whether the HSV test was included into my previous blood tests.
However, the doctor told me what I have doesn’t look like herpes. He diagnosed mild balanitis.

The fact that these symptoms have been constantly on and off the last few months makes me think it wouldn’t be herpes as herpes outbreaks only occur every few months within the first year.

As I’ve said I’ve had close to 20 re occurrences in the last 5 months. I’ve been washing with nothing but warm water once a day.

At the moment washing the glans immediately after friction and hair drying the glans seems to be keeping the symptoms at a bare minimum.

I also forgot to note that the morning after the encounter my penis was very very swollen and sore. It felt like bruising and was very wide. Not sure if this is linked.

Also the fact that my current partner and I have had unprotected intercourses multiple times and she has never once mentioned any symptom.

Dr. Kakkar

Dermatology HIV/AIDS Specialist Venereology
# I suggest you to take a blood test for HSV by ELISA (HerpeSelect} of you are not sure whether it was done earlier. Genital herpes can have frequent recurrences. The frequency of recurrences decrease with time, over the years. The fact that you have a sort of that are recurrent does mandate that you be tested for genital herpes. If your partner hasn't had any such complaints it does not automatically imply that it is not herpes. The frequency of episodes may vary between individuals and with the duration of infection e.g if she has had herpes for years, she may not have very frequent recurrences whereas for if it's a recent infection then you will have more chances of frequent recurrences.

You may also take a PCR for HSV DNA from the sores, if and when you develop them again. PCR is more sensitive and specific than a blood test (HerpeSelect}

Once genital herpes has been convincingly ruled out by testing the only other possibility is that of non specific bacterial balanitis for which I have advised you to use a topical antibiotic ointment.
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