Q. Whenever I urinate, I get burning sensation and red rash on the head of penis. What it could be?

Hello doctor,

A year ago I urinated and the urine appeared very yellow and there was a burning sensation. Within a few hours, a reddish/brown rash appeared on the head of my penis that lasted three to four days and then disappeared as quickly as it appeared. However, I have been left with a myriad of symptoms that have persisted for a year. I have seen numerous physicians without any successful diagnosis or treatment. Please find below a list of both symptoms and treatments with success level besides. Please ask me any questions you might need to in order to help in the diagnosis and I will answer to the best of my ability. I can also provide the test results that I have gone for and my difficulties in obtaining certain tests.

Symptoms persistent for one year: Redness and irritation around the urethra opening, chronic dysuria, shiny/waxy appearance on the penis gland, inflammation of the penis gland, burning, stinging, and painful ejaculation, redness and burning sensation in scrotum/testicles, and tingling sensation in testicles. Treatments received over the year: Antifungal medications: Viaderm KC, Flucanazole, Hydrocortisone 1%, Canesten, Lamisil (Terbinafine 250 mg cream and oral tablets). Dermatological treatments: Protopic, Moisturizers. Antibiotics: Doxycycline one week followed by Azithromycin 100 mg this treatment worked well and the problem disappeared only to reappear a month later, Ciprofloxacin two weeks (no results), Doxycycline 1 month (no results), Moxifloxacin 10 days (good results, but issue still present).

Tests: I have tested for the following STD’s and they have returned negative: chlamydia, gonorrhea, syphilis, trichomonas’s, HIV, and HSV2. It has been very difficult to test for mycoplasma genitalium. I have stopped washing my penis and genitals with soap and only rinsing with water. I have also switched to a sensitive skin body wash soap and I am wearing loose-fitting boxers. The boxers help a bit as every time I move it is painful and makes the irritation worse. This has unfortunately caused major problems in my life, I used to run marathons and I am no longer able to go running, some days I have difficulty walking it is so painful. All of this has led me to seek counseling as depression has started to set in as there does not seem to be much relief from these symptoms insight. I am really hoping that you can help.

Thank you doctor,

I have stopped running all together so there is no friction. I have also gone for a urinalysis and it came back negative. I will be doing a semen analysis this Thursday but I do not think it will show much. I have also done a glucose fasting test and my insulin levels were normal so it is not diabetes. There is a history of diabetes in my family so that was a concern. It has become a chronic condition. So maybe treating is no longer an option and managing the symptoms is the way forward? My symptoms, from, what I can tell from medical journals and articles would be similar to chronic prostatitis or urethritis. But, I am not certain how those conditions would be managed. Are you able to suggest any medications or treatments that would help manage these symptoms? For instance antibiotics, anti-inflammatories, or pain killers, or some other methods for dealing with the symptoms?