What does having a red pimple in the penis glans indicate?

Hi,

Welcome to icliniq.com.

Having gone through the history provided from your end, the chances of acquiring a sexually transmitted disease or sexually transmitted infection, especially since the STI (sexually transmitted infection) panel tests showed negative repeatedly, would be less. As you mentioned, they may not be herpes or sexually transmitted infections. However, since your doctor has had a chance of direct consultation and physical examination, which were done following a confirmative diagnosis might have been reached. In the absence of an image for inspection and assessment of the same from my end, I would like to request you provide an image attached through the image option in the query section provided so that I may be able to inspect and assess the lesion for its type and severity and I would be able to provide a confirmatory diagnosis for the same along with an appropriate management plan as well.

As multiple factors lead to the formation of a single red lesion on the glans (penis) along with inflammatory responses on the foreskin, inspecting the lesion becomes mandatory to provide a diagnosis for the same.

In case of difficulty in providing the image of the lesion, I would also like to request you to undergo a biopsy of the lesion wherein, the particular issue would be excised, and the tissue inside the lesion would be examined under a microscope to see the type of cells which are present in them and to provide a confirmative diagnosis which would be the ideal way of investigation of a lesion on the glans (penis).

Usually, if the STI (sexually transmitted infection) panel tests are negative following the possibility of exposure to an infected person. It is advised to undergo a repeat STI panel testing two or three months post-exposure. Since there has been repeated negative result, the chances of an STI would be less.

However, assessment of the lesion and investigations are important in reaching a confirmative diagnosis for the same.

Kindly revert back with the necessary details for further management options.

Thank you.

Hi,

Welcome back to icliniq.com.

After viewing the image (attachment removed to protect patient identification) of the lesion provided from your end and the report of the STI (sexually transmitted infection) tests done, it does not appear to be genital herpes. Genital herpes usually goes through various stages, including stages of itching, burning sensation, pain, blistering, bursting of blisters, formation of raw skin, or ulceration with secretions, pain, and inflammation, which eventually heals by scabbing.

On viewing the image, the condition appear as balanitis is basically an inflammatory condition affecting the glans (penis) and foreskin, which may be due to multiple factors, including fungal, bacterial infections, eczema, psoriasis, autoimmune conditions and idiopathic causes. They may also appear due to using harsh and strong chemicals, soaps, or shampoos to clean sensitive and private areas due to hygiene issues, other underlying medical conditions, and cases of any other skin disorders.

Currently, they appear as eczematous lesions leading to balanitis. Apart from the same, the image also shows the presence of PPP, which are pearly penile papules. PPP are harmless pearly white multiple and tiny growths that are most commonly seen on the ring area of the glans (penis). They appear to be a part of a normal phenomenon and may appear and reappear and do not require the usage of any medication. On the image, there appears to be fordyce spots as well, which are harmless red, white, or skin colored raised lesions that may be present as a single lesion or multiple nations as a part of a normal phenomenon and require no treatment.

Balanitis usually appears as red to white spots and white scales, dry flakes to scales, and redness and may also appear to have secretion or oozing. They may present with no symptoms at all, but some may also experience itching, pain, discomfort, burning sensation, and burning during urination. As you have not undergone the various stages of genital herpes as mentioned above and the characteristic of the lesion matches with the symptoms and the appearance of balanitis, The most probable diagnosis would be the same.

They may appear on and off but may be managed.

My advice :

1. Clotrimazole cream is to be applied on the affected area in the morning and in the afternoon for eight weeks or till the rashes reduce. Terrasil cream (clotrimazole 0.1%) is a brand available with the content.

2. Fucidin H cream (Fusidic acid hydrocortisone cream) is to be applied at night in a very thin layer in a very small quantity on the affected area for four weeks. Do not apply in deep cuts or wounds. Make sure to apply on areas that are scaly and dry.

3. Lukewarm salt water to be used to wash the affected area in the morning daily for two to three minutes.

4. Oilatum emollient or Oilatum bath formula may be added in the amount of two caps full (cap of the bottled medication) to be mixed in one liter of water (normal temperature). It may be used to wash the affected area daily in the morning.

5. Capsule Omega 3 once daily at night after food for two months. They help with reducing dryness.

6. Make sure to keep the affected area moisturized and avoid using harsh chemicals, soaps, or shampoos to wash the area.

7. Wick and Strom penile care cream (active ingredient vitamine E and C) may be applied twice daily on the affected areas. In the morning and evening, they may be used half an hour after applying the medications mentioned above. They help in keeping the area moisturized.

8. Ensure using more fruits, and vegetables and make sure to consume at least 15 glasses of water (250 ml standard glass size) per day. Kindly avoid milk, dairy products, red meat, sweets, and fried and oily food.

9. In case of severe balanitis, they may require surgical intervention and therefore in such a situation. I would like to advise you to consult a surgeon in person for an assessment of severity and to provide management options for the same.

10. In case of the presence of secretion, they may be investigated with a swab test done at a dermatologist's office or at a laboratory where the secretion is taken for culture and sensitivity, which helps in ruling out the presence of bacteria or fungal elements and also may provide an antibiotic or antifungal to which the organism is most sensitive.

11. As I have mentioned earlier, due to the diagnosis from your doctor, who has already done a personal examination and the diagnosis made from my end based on the appearance of the lesion through the image provided and the test reports provided. The ideal investigation which would help in reaching to a confirmatory diagnosis would be a biopsy. However, in the absence of symptoms and if the papule is not bothersome, a biopsy is not mandatory. A biopsy will help in finding a confirmatory diagnosis and would be helpful in providing the appropriate management.

Having said that, it may take a few weeks to months for the lesions to fade, so it is advised to continue the medication consistently. Fucidin H cream, a strong cream, is not advised to be used for more than four weeks. If they continue their usage, they need to be discontinued for three weeks following the first four weeks of application and then continue again for four weeks following a break of three weeks.

Hope the details are informative and provide clarity.

Kindly follow up in case of further queries.

Thank you.

Hi,

Welcome back to icliniq.com.

Due to the presence of white scales and dryness on the glans (penis) as per the information provided from your end, as well as which I have observed in the image provided (attachment removed to protect patient identity), the rest of the medication including the Oilatum (Liquid Paraffin) and moisturizer which I have prescribed would help in reducing the dryness over the glans (penis).

Balanitis may cause symptoms of pain in the penile area as well as redness of the foreskin as well when coupled together. They are usually referred to as balanoposthitis. Masturbation can also form balanitis due to post-traumatic inflammation, which is caused as a result of vigorous masturbation.

Painful ejaculation is usually caused due to an underlying inflammation or infection, which most probably are infections of the urethra, prostate gland, and testes. And are not necessarily associated with STIs (sexually transmitted infections).

Since you have also done tests before being diagnosed with herpes by your doctor, such should have shown positive in the presence of the herpes virus. Since it was negative throughout, it does not appear to be herpes. While on medication, there might be variations and chances of false negative results in the blood tests. However, the chances of herpes are less due to the negative result consistently.

As I have mentioned above, a biopsy in case of recurrence of the papule may be ideal for reaching a confirmative diagnosis. Polymerase chain reaction or PCR and HSV2 antibody testing may be done after a period of two months in order to rule out the presence of herpes viral load as well as to detect any past infections which can be seen via the antibody testing.

Hi,

Welcome back to icliniq.com.

Yes, the presence of balanitis and balanoposthitis, then maybe mild to moderate pain and multiple other symptoms, as mentioned above, on the tip as well as the glans (penis) and foreskin. Apart from the treatment mentioned above, oral medications for pain may not be necessary unless the pain is intolerable. In case of unbearable pain,

1. Tablet Aceclofenac and Paracetamol may be taken twice daily after breakfast and after dinner orally for three days. This is an anti-inflammatory and analgesic combination. In case of a previous history of allergies to anti inflammatories or any medication in general, this medication needs to be avoided, and plain paracetamol may be taken.

2. Tablet Pantoprazole 40 mg twice daily, 30 minutes before breakfast, and 30 minutes after breakfast, may be taken for three days. Pantoprazole helps prevent the formation of acidity, a common side effect of the medication advised above. It also must be noted that, before consuming the Aceclofenac plus Paracetamol combination, enough food must be consumed to prevent abdominal discomfort as it is a strong medication.

Balanitis and balanoposthitis may occur depending on the previously mentioned factors, which results in their formation. Each time they recur, the management options may be continued as above.

As for the intake of antiviral medication, it is advised to consult your doctor. It was prescribed from their end, and advising to stop the medication or changing the dosage of the medication may be inappropriate from my end.

In the absence of the lesions and any other symptoms and following the stopping of the medication, you may wait for four weeks before undergoing the tests again for a confirmatory diagnosis.

Thank you.

Hi,

Welcome back to icliniq.com.

Yes sure. Kindly follow the same.

As per the previous reports, which have been attached (attachment removed to protect the patient's identity) there is no need to undergo the tests again, and the tests are conclusive. However, you may undergo the herpes test following four weeks. Kindly revert to the reports for further management.

Thank you.

Hi,

Welcome back to icliniq.com.

Yes, usually, in the absence of the herpes virus and herpes antibodies, which have been non-reactive in the results, the chances of having been infected by the herpes virus are less. However, in rare cases, there might be a possibility of herpes without the viral load. However, in your case, since you have undergone multiple tests repeatedly before and after starting the medication and have still shown negative results, it has the least probability of herpes.

Having said that, in my practice, no patient has shown any herpes symptoms or lesions with negative testing of the same.

However, It is still ideally advised to undergo a repeat test after four weeks for a confirmatory diagnosis. As per the image provided from your end, it appears to be balanitis from the appearance of the glans (penis) and foreskin.

Thank you.

Hi,

Welcome back to icliniq.com.

Fusidic acid and Hydrocortisone (Fucidin H cream), which I have previously prescribed, are a combination of steroids and antibiotic creams. Therefore a prescription might be needed to purchase them while in medical stores. This medication may be avoided without symptoms, as mentioned earlier, including redness, itching, and burning sensation. However, in the presence of the symptoms, it is advised to be used in a very small quantity.

The rest of the medication that has been prescribed can be availed without a prescription and maybe directly purchased online as most of the medications are available online.

Thank you.

Hello,

Welcome back to icliniq.com.

Since you are experiencing pain and discomfort at the end and the inside of the penis, it is advised to undergo a urine routine and urine culture and sensitivity testing wherein an amount of urine sample will be tested for the presence of any bacteria or any other fungal infections as well as to rule out any other underlying medical conditions which cause the discomfort as well as pain sensations at the end of the penis and within the urethra. I would also like to advise you to do the test and provide the reports in order to provide a management option to reduce its intensity. For the time being, it is advised to continue the current medications and undergo the test as well.