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Q. I have a painful rash along with an ulcer on my penis. What could that be?

Answered by
Dr. Shama Naaz
and medically reviewed by Dr. Vinodhini. J
This is a premium question & answer published on Dec 01, 2020

Hello doctor,

I have a single ulcer on my penis shaft where the doctor prescribed Keflex and Bactroban ointment. He also has a swab for chlamydia and blood tests for HIV, syphilis, hepatitis, etc., which all came back negative. I applied Bactroban on the ulcer and around the skin and decided to masturbate. About 30 minutes later, a red rash with tiny vesicles appeared. The next day, I tightened my skin and burst them quite quickly, releasing clear fluid, leaving a small cut. The cuts are now painful to touch. The rash and tiny ulcers look better immediately after moisturizer or applying cold compression. It does not seem to be itchy. The first ulcer I had now has been swabbed for HSV-2, but the doctor said it is unlikely to be that, but an infected bacterial infection. I am concerned about the present rash.

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#

Hi,

Welcome to icliniq.com.

Ulcer on the shaft of the penis can be due to different reasons like herpes genitalis, local trauma, or secondary bacterial infection, and some STDs (sexually transmitted disease).

Was there any pain associated with the appearance of an ulcer? Is there any painful or painless lump in the groin area? For the rash, is there a burning sensation before the appearance of vesicles and redness? Do you have a history of unprotected intercourses recently or any urethral discharge? Did you have a similar reaction when you use Bactroban cream?


The Probable causes:

Irritant contact dermatitis due to topical medication. Herpes genitalis.

Investigations to be done:

Reports of HSV2 (herpes simplex virus) and NAAT (nucleic acid amplification test) test for chlamydia.

Differential diagnosis:

Rash. Irritant contact dermatitis.Herpes genitalis. Ulcer. Local bacterial infection or STD (sexually transmitted disease).

Probable diagnosis:

To be made after reviewing reports.

Treatment plan:

Apply topical antibiotic cream over the ulcerated area. Do not apply over the rash. Proper treatment plan after getting reports.

Preventive measures:

Avoid sexual activity until the lesions are healed. Do not masturbate. Do not burst any vesicles by your hand, you will only aggravate the problem.

Regarding follow up:

Review with reports.

Thank you doctor,

There was no pain on the initial ulcer. No burning or tingling before the secondary rash. No lumps in the groin area and no discharge. I am sexually active. And this is the first time I am using Bactroban. This is what the rash looks like after two days from the first photo. Could this be eczema?

#

Hi,

Welcome back to icliniq.com.

Burning and itching before the onset of rash is commonly seen in herpes, but some patients may not complain. So, I would not rule that out without seeing the report. Making a confirmed diagnosis is essential in herpes because, without treatment, there is a chance of recurrence.

According to your history, rash appearance came after applying Bactroban and coupled with friction in the area due to masturbation. It could be irritant contact dermatitis, which will go away with time and topical medication only.

There is no history of urethral discharge or lump in the groin area, and your test reports are negative for HIV, syphilis, and chlamydia.


The Probable causes:

Due to irritation from topical medication or herpes.

Investigations to be done:

HSV report awaited.

Differential diagnosis:

Irritant contact dermatitis.

Probable diagnosis:

Herpes genitalis.

Treatment plan:

Apply calamine lotion over the red area and topical antibiotic (other than Bactroban) for ulcer. (Patient had already taken oral antibiotics). If the HSV report is negative, mild topical steroid cream for the rash is advisable.

Preventive measures:

Avoid sexual intercourse, masturbation, and manipulation of local lesions.

Regarding follow up:

Review with reports.


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