What is the diagnosis of red rash that appears on the head of penis with burning urination?

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

Answered by
Dr. Samer Sameer Juma Ali Altawil
and medically reviewed by Dr. Vinodhini. J
This is a premium question & answer published on Jul 21, 2020 and last reviewed on: Jul 25, 2023

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.



Welcome to icliniq.com.

Thanks for the detailed history and presentation with pictures (attachment removed to protect patient identity). Your problem has been there for a long and you had a thorough investigations done and you tried many treatments. Persistence of problem might be related to chronic diseases like diabetes as well. You have been on a variety of antifungal and antibiotics. But before that did you do urine culture or semen culture? In view of chronic dysuria and painful ejaculation you might be having chronic prostatitis. Do I need more information about whether you had this issue before many years ago? Any chronic medical problems like dIabetes, hypertension, vascular diseases, or previous chronic medical diseases like tuberculosis or sarcoidosis? Investigations will be urine for analysis and urine for culture then semen culture. No need for any treatment at the moment until further results. If results are negative, then you will need a biopsy of your glans to see the histology to reach a definitive diagnosis. Irritation when you are jogging or running is due to inflammation of glans and wearing loose clothing might increase it as it cause more friction. I advise to use good fitting underwear. Please follow up with the answers and investigations.

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?



Welcome back to icliniq.com.

Note: Semen, I requested is for culture and not analysis. Treatment of chronic prostatitis is difficult usually some patients responsd to one type and others respond to another type of treatment. It can be bacterial or abacterial we see the result of semen culture. Generally, the first line of treatment is antibiotics (but this will be after your culture result), alpha-blocker pain relief medication with anticholinergics. At this time I would only prescribe Tamsulosin 0.4 mg once at night. Please follow up with the culture result and let me know the response to Tamsulosin. Usually, response to Tamsulosin will be after three days of use. Other medications can be replacing or adding to it accordingly.

Hi! I received my results from the semen culture. it read:
Rare neutrophils
Rare gram positive cocci
Mixed gram positive organims - suggestive of urethral flora

I dont know what this means though. Are you able to explain to me? Thabk you.
# Hi and thanks for your follow up
The result is negative for any active infections. Gram positive cocci can be there in the skin normally therefore you don’t have active infection so far. Chronic prostatitis can be bacterial or abacterial. How is the treatment I prescribed before for you tab tamsulosine going on if it’s not really effective you can add tab. Detrositol 5 mg twice daily. The dose can be increased according to response therefore you are encouraged to follow up. I will follow you after say 2 weeks to see the response.
Please don’t hesitate to ask if you have any more queries. Kind regards and best wishes

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