Q. Why do I have red spots and persistent irritation in my penis that is not responding to any treatment?

Hello doctor,

My penis is irritated. I have red spots on its glans, and sometimes I have white spots. After having a bath (only with warm water), it worsens. After urinating, I have a burning sensation, and even the underwear irritates me. Sometimes I feel coldness in my penis, colder than it should. It is inflamed most of the time, including the region of the outlet of my urethra. The only way I can avoid this bad sensation is to bandage my penis so that nothing can irritate it. I have had this issue for about a year. I contacted several doctors (urology, venerology). We tried steroid cream, antifungal, and antimicrobial cream. I used oral NSAIDs and took antibiotics, but no improvement in symptoms. I changed my washing machine gels. My urine samples are negative, and my semen samples are negative. After the prostate massage, the secretion is also negative. The cotton swab samples they took for STDs (gonorrhea, ureaplasma, mycoplasma, syphilis) are negative. Sometimes I also feel this around my anus and the anal canal. I have small external hemorrhoids. 75 % of the time, I can feel the discomfort. It exacerbates after sex, or after bath (not using any shower gels, just water), and sometimes after urination. My wife is also tested negative and has no symptoms. We are monogamous.

My ultrasound report states the following.

1. Prostate status: homogenous, normal size (with a rectal exam).

2. Bladder status: normal.

3. Testicle status: normal, not inflamed.

My blood and urine report states the following.

1. CRP: normal.

2. Bacteria in urine and penis: negative.

3. Fungi in urine: negative.

I have taken the following medications.

1. Esomeprazole 40 mg daily.

2. Oral antibiotics (Sultamicillin, Doxycycline, Ciprofloxacin).

3. Steroid creams (Prednisone, Hydrocortisone).

4. Antifungal creams (Tioconazole).

5. Antibacterial creams (Gentamicin).

6. Combination creams (Boric and Salicylic acid).

The urologist told me that I might have non-bacterial prostatitis. I am clueless and in pain. I cannot live with this anymore. Please help.

Hello doctor,

Thanks for your reply.

The last digital rectal exam was performed two months ago. It was very comfortable, and I did not feel any pain as far as I remember. After the ultrasound, I got my reports. The result:

1. Prostate status: homogenous, normal size.

2. DRE: normal texture.

2. Bladder status: normal, half-filled.

3. Testicle status: normal, no inflammation.

I used OTC drugs, NSAIDs, and herbal medicines like Saw Palmetto, Pumpkin oil, Epilobium parviflorum tea, and Rye pollen (Pollstimol). After a couple of months, my symptoms went away, but they returned after a few months. I contacted a new urologist two months ago because my previous urologist passed away because of COVID. The new doctor did not perform any digital rectal exam, and only a blood test was done (the reports were normal). My semen sample was also negative. He only told me that he thinks I have nonbacterial prostatitis. My symptoms still existed, so I contacted a venereologist and a dermatologist. They took samples, but they were all negative.

I have taken the following medications in the last one and a half years.

1. Fosfomycin.

2. Ciprofloxacin.

3. Sultamicillin.

4. Doxycycline.

The red spots on my penis are not going away. These inflamed spots are still there. The other symptoms are not present (present on rare occasions). There are only size changes. I used a lot of creams (steroids, antifungal, and antibiotics), ointments (Boric acid, Salicylic acid), and anti-inflammatory creams. Still, my urine irritates my skin and sometimes my urethra, but only the last one centimeter. You can see the inflamed region around my urethra outlet in the pictures. After urinating, sometimes I visualize white and red spots. The dermatologist and the venereologist do not know the answer. I was waiting for a proctology examination. Today there was mucous discharge in my excretion. I have attached the pictures below. Can a proctitis or a rectal inflammation be considered as a source?

Thank you.