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

Answered by
Dr. Samer Samer Juma Ali Altawil
and medically reviewed by iCliniq medical review team.
This is a premium question & answer published on Mar 06, 2022

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.

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#

Hello,

Welcome to icliniq.com.

The symptoms you have described indicate urethral pain syndrome. Another possible diagnosis is chronic abacterial prostatitis. Examination of the prostate to look for inflammation by inserting a finger in the rectum and feeling the prostate is the key to diagnosis. I am sure you got it before, especially when you had a prostatic massage. Was it painful? If there is no pain, then it is not prostatitis.

The cause of pelvic pain syndrome or chronic urethritis is usually idiopathic. It means it has no cause, and there is inflammation of the urethra with no apparent reason. Many treatment modalities like antibiotics, alpha-blockers, acupuncture, and laser therapy can be used.

Diagnosis of pelvic pain syndrome or chronic urethritis is always a diagnosis of exclusion. Urethral pain syndrome is diagnosed once all tests are negative and symptoms persist for six months.

I hope I have answered your questions.

Kind regards.

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.

#

Hello,

Welcome back to icliniq.com.

I have gone through the pictures (attachment removed to protect the patient's identity).

From your description, it seems that you have chronic abacterial prostatitis. Treatment, as you mentioned, includes NSAIDs (non-steroidal anti-inflammatory drugs) and herbal medicines like Palmetto, Pumpkin oil, Epilobium parviflorum tea, and Rye pollen (Pollstimol).

The treatment should be repeated if the symptoms are recurring.

Regarding the spots, a biopsy is important for diagnosis, or a dermatologist review can be helpful. I suggest you use the previous medications. Prostatitis is a naturally reoccurring condition, and for spots on the penis, take a dermatologist's opinion.

I hope you will overcome the issue.

Kind regards.


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