What would cause the red spots on the penis to reoccur even after treatment?

Question

Hello doctor,

Three months ago, I got four to five red spots on the head of my penis. I consulted a doctor, and he suggested that it may be due to yeast infection or penile balanitis. He thus insisted on using a Canesten 1% (Clotrimazole) and Hydrocortisone 1% cream for seven days and continue further for 14 days with Clotrimazole alone. With this strict regime and advice, I have applied it twice daily after shower, and the spots slowly started disappearing. Unfortunately, I was busy with some family functions, and I had forgotten entirely about applying the ointments for about three days. I noticed the same spots appearing again and thus decided to consult the same doctor again, and he insisted on starting a fresh cycle of the combo. Thankfully, the spots have gone up, completing my treatment.

But after two months, I noticed similar red spots on my penis (refer to pictures) and was surprised as I thought I was cured from it. I am very hygienic, and I wash my penis twice a day with soap and water by pulling back the foreskin (non-circumcised) and washing them. I took a general health report two months back, and there was no evidence of diabetes. I also took an HbA1c test to rule out diabetes (picture attached). My queries are:

1. Why are these red spots on my penis coming back again?

2. Why does it seem worse than before, which was just minor red spots?

3. I consumed alcohol (beer) 3 days ago. Would this be a reason for recurrence?

I have also taken an STI test to rule out any possibilities out of fear as the internet suggests it could be due to STIs (reports attached) such as HIV, HSV 1 and 2, and HIV test. I have done two sets of a 4th generation HIV test with about ten days gap in between, and also have taken a rapid test (HIV 1and HIV 2 antibody) test. All of which came out negative. I would humbly seek your advice on this confusion.

Thank you.

Answer 1

Hello,

Welcome to icliniq.com.

I read your query and understand your concern.

Kindly answer the following questions so that I can guide you properly.

1. Are you sexually active?

2. Are those red spots on your penis painful and itchy?

4. Is there any discharge from those lesions?

The penis is a very sensitive structure, and I do not recommend cleaning it with soap every day. Soaps or detergents often cause chemical balanitis, which is nothing but inflammation of the glans penis. Instead, I suggest you wash it with water, pat it dry, and keep it open for a few minutes daily after showering once daily. Please do not overdo it. You may continue Clotrimazole cream for a few more days. Steroid (Hydrocortisone) cream at this time is not recommended. It may take a few days for them to disappear completely.

Thank you.

Answer 2

Hello,

Welcome back to icliniq.com.

I wanted to know about your sexual history to rule out any other possibility of sexually transmitted diseases (STIs). It will be fine, and I do not think it is a sexually transmitted disease backed by your reports. My close differentials were balanitis and eczema, which is why I had those questions about pain and discharge from the lesion. In the absence of those symptoms, eczema is a high possibility. It is not fungal as you have no risk factors for that, and Clotrimazole would have solved it by now. I suggested Clotrimazole as it is both effective against fungal and bacterial infections.

Do not use soap to clean the penis area. Plain water should be good enough to clean the part once daily. The other doctor is right to start steroids. Note that you must taper the steroids before stopping the same slowly. I am sure the doctor might have informed you of this. Also, it may take some time to heal, so do not bother to see if it is not getting resolved in a matter of days.

Thank you.

Answer 3

Hello,

Welcome back to icliniq.com.

I have reviewed your reports (attachment removed to protect the patient's identity), and all the screening tests for sexually transmitted diseases (STIs) are negative. Therefore, I suggest you take the following measures.

1. Clean the penis only with plain water, pat it dry and apply the medicine Hydrocortisone after retracting the foreskin. Keep it open for some time, and then you may reposition it.

2. Do this for three weeks as your doctor suggested. After three weeks, apply on an alternative day for the next week and then twice weekly. This is what I meant by tapering (slowly reducing the dosage). This is required when you are using steroids. Else you will have a recurrence.

3. Avoid using soap or detergent over the glans penis as it is a sensitive organ. Plain water is sufficient.

4. Avoid tight inners and clothes.

I hope I have answered your queries.

Thank you.