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,
Four days ago, I felt a burning sensation whenever something touched my penis. Then the skin started to break, and lesions appeared. I also have prominent mouth blisters or ulcers that started as blood blisters and became an ulcer. I will attach the images of the mouth and penis. I have been with a single partner for six months, and my STD panel was negative six months ago. I also tested for syphilis and HIV. Both turned out to be negative.
Hi,
Welcome to icliniq.com.
I understand your concern. Erosions and ulcers are visible in your report (attachment removed to protect the patient's identity). I suggest the following. Apply Mucopain gel (Benzocaine) before eating food thrice daily for ten days. Take Tablet Zifi 200 mg (Cefixime and Ofloxacin) twice daily after food for five days. Take Tablet Omnacortil 10 mg (Prednisolone) after breakfast for five days. Apply Fucidin cream (Butylhydroxyanisole, Cetyl alcohol, and Potassium sorbate) or T-Bact cream (Mupirocin and Bromelain) twice daily for seven days (on penile lesions). Take Capsule Becosule (vitamin B1, B3, B6, and B2) once after dinner for ten days. Avoid scratching and rubbing lesions. Take Syrup Cital 3 ml twice daily for seven days. Wash genital area with gentle Cetaphil cleanser for one month. Get HSV 1 and 2 (herpes simplex virus), IgG (immunoglobulin G), and IgM (immunoglobulin M) levels checked. Avoid eating spicy, hot food and beverages. Eat a bland diet. Please answer the questions for details. Do you have a fever? Do you have any drug history or drug allergies? Have you tested for herpes?
Patient's Query
Hi doctor,
Thank you for the reply. No fever, but I had some chills three days ago and sore lymph nodes (neck area). Not sure about the past herpes test, but I will get one done as soon as possible. Drug history and allergies: No allergy. I took Augmentin antibiotic seven days after an appendectomy six weeks ago and got a steroid injection for a herniated disc ten days ago. I have also been taking garlic and curcumin supplements. I started taking Fluconazole 200 mg, Mupirocin 2 % ointment (penile area), and Lidocaine gel today as per the doctor's recommendation for candida infection. He also recommended using Vaseline three times a day in the genital area.
Hi,
Welcome back to icliniq.com.
I understand your concern. Please get tested for HSV 1 and 2, IgG, and IgM.
Patient's Query
Hi doctor,
Thank you for the reply. Should I cover the erosion with a band-aid or something else after washing and applying the antibiotic? I applied one today, and it stuck to the skin and peeled off, making things worse. Also, the first doctor suspected a rare auto-immune disease called pemphigus vulgaris and discussed its testing options. What is your opinion about this?
Hi,
Welcome back to icliniq.com.
I understand your concern. Pemphigus vulgaris presents with oral mucosal lesions too. It is a vesiculobullous disorder or blistering disorder. Also, the back is commonly affected by it. There are erosions or blisters in it. Pemphigus is one of the differential diagnoses with herpes as herpetiform ulcers that appear in groups and are tiny. Oral steroid is one option with multivitamin supplements with Povidone Iodine gargles. If HSV 1 and 2 test comes positive, take Valacyclovir tablet 1 g three times daily after food for five days. Continue applying Mucopain gel before eating food for ten days. Povidone Iodine gargles with lukewarm water for ten days. Maintain proper hygiene. Follow up with reports. Do you have any lesions, erosions, or vesiculobullous lesions on the body? Pemphigus lesions mainly occur on the body, and sometimes oral mucosal involvement is seen.
Patient's Query
Hi doctor,
Thank you for the reply. There are no lesions on the body except the mouth and penis. It seems like 50 % to 70 % of pemphigus cases start in the mouth exclusively. Sometimes it is the only symptom from start to end. Given that pemphigus is one of the differential diagnoses with herpes, getting the herpes test done will probably shed some light. Please answer my question about covering the penile area and especially the lesions.
Hi,
Welcome back to icliniq.com.
I understand your concern. Yes, mucosal pemphigus vulgaris is the differential diagnosis. Complete blood count with LFT (liver function test), RFT (renal function test), lipid profile, BSL (blood sugar level), differential count, urine routine, and HSV (herpes simplex virus) tests all need to be done.
Patient's Query
Hi doctor,
Thank you for the reply. After applying the antibiotic lotion, should I cover the penile area with a band-aid?
Hi,
Welcome back to icliniq.com.
I understand your concern. Do not cover it. Avoid occlusion. You can apply Povidone Iodine ointment with cotton.
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Venereology
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