Sexually Transmitted Diseases/cracked glans follow up ?


balanitis 2
balanitis 2  

Firstly thanks for your time at this forum. I recently have read many of the previous posts and found them to be very informative. I have self diagnosed with balanitis based on google image comparison.  The rash is quite odd and my urethera is red and inflamed skin all around except for a small portion that you may not see clearly on the photo.  You can tell the texture there is normal still.

I heard you mention some otc anti-fungals for balanitis, but do you know if Butenafine could be effective?  I am quite concerned, particularly about the change in texture of the skin with vertical striations that were not there previously. I saw a dermatologist but I did not use the cortizone cream as I consider this to be related to an acquired infection.

Symptoms appeared 3-4 weeks after unprotected oral followed by protected vaginal sex. Within 5 days of the encounter I developed intermittent symptoms of itchy urethra, uncomfortable/painful urination, post ejaculatory pain.  Eventually they became more persistent, along with low grade fever, muscle spasm/shakes, chills, some night sweats, painful/sore testicles after sitting.  

I finally went in for treatment after this rash appeared, but I am not sure I am on the right Rx for treating an STI.  I have had some improvement, especially with the painful urination, but I have been on Cipro for ~ 3 weeks.  I am wondering if I have acquired something that this drug is not effective for as I am still having symptoms such as this rash, mild tingling upon urination at urethral tip, low grade fever, testicular soreness.  The rash is not itchy (although I feel an mild itch/ache inside my urethra still) but the skin does feel almost sunburnt with loss of sensitivity, and I am already circumsized.

I had a urine NAAT tests for syphillis/ghonorrhea at 2 weeks followed by tests at 4 weeks: HIV & STD antibody testing, urine culture, urinalysis and at 40 days post exposure:  HIV-RNA PCR , all were negative thus far.  I plan to repeat the syphillis soon.  I have tried different a few creams for this condition, such as an antibiotic cream, vaseline, antifungal (w/butenafine).  Nothing helped.

I am very worried I have had this rash for weeks, should I be prepared mentally to be physically stuck like this?  Am I past the effective stage of antibiotics?  Are there any other tests I can ask the dr. to run that my help shed light on the cause?  Thanks again for your time and expertise!

ANSWER: Hello Sergio,
The photos of your penis look normal, and do NOT reflect balanitis. I can't say you don't have balanitis, but the photos do not support this self diagnosis or any type of rash. The vertical striations on the glans may be a normal variation in the skin.

Besides the appearance of the skin, you mentioned an itchy urethra, uncomfortable urination, post ejaculatory pain. This is more concerning. Low grade fever means a temperature of around 100-101, not 99. Measuring your temperature during the day will establish a normal daily variation that may range from 96-99 based on when you take it. Muscle spasm, chills, night sweats all can be related to having a bacterial or acute viral infection. "Painful testicles" is also a disturbing symptom.

Prior to receiving an appropriate antibiotic, an accurate diagnosis must be made. Hopefully, the doctor who prescribed the ciprofloxacin ("Cipro") did so, rather than just prescribe it blindly, without examining you or conducting necessary tests. I am unaware of the availability of a urine NAAT test for syphilis. Such a test is done for gonorrhea and chlamydia, but syphilis requires a blood test, not urine. However syphilis would not cause a constellation of such symptoms.

The butenafine is an effective antifungal, but not all antifungals are effective for all fungal infections! If an accurate diagnosis is made, and you really do have a skin fungus, then it might be worthwhile to switch to a different antifungal. But was an accurate diagnosis done?? You might have just a contact dermatitis from all of the creams you have recently used.

The doctor is the expert, who should have an appropoach that includes ruling in or out certain common problems that may contribute to this symptom complex. I would concentrate not on the gross appearance of the skin of your glans, but more on your testicular pain, your fevers (if they are documented), etc. A "compete blood count with differential (CBC/diff)" will point to a bacterial, viral, or other potential cause if the infection is systemic. It will be perfectly normal with acute gonorrhea, syphilis (which I don't think you have from your symptoms), chlamydia, trichomonas. It is unusual for both testicles to be involved in any infection. Most cases of orchitis or epididymitis (are caused by mumps!) involve only one side, and may be due to gonorrhea or chlamydia.

You see, this is somewhat complicated. You need to speak with your health care provider about this.

Good luck!

---------- FOLLOW-UP ----------

red crack glans
red crack glans  

cracked glans with redness non itchy
cracked glans with red  

I appreciate your time in regards to my prior post, but I ask you to take a 2nd look and reconsider as I uploaded better photos.  The vertical striations on the glans were not there and the color was not red previously to onset of the condition.  The glans skin was smooth and normal looking, now it is constantly red, cracked, and without itchiness but occasionally feels slightly painful, almost like a mild sunburn or slightly achy urethra, sporadic and brief sensations usually.     

Now that some time has passed my most common symptoms are still occasionally urinary discomfort, hot skin without a fever, occasional testicular ache (if I sit too long), and some other symptoms.   The Drs. were treating me for prostatitis (based on DRE) and then NSU/NGU (based on my - test results and urinary symptoms), but I finished their pills many weeks ago.

Yes I meant NAAT test for gonorrhea and chlamydia, and RPR for syphilis.  I have had those repeated in addition to antibody tests for HIV 1/2/o (~14 weeks post exp), hepB, hepC, HTLV 1/2, Shistomoas, Chlamydia (igg); Hep B SurfAG; NAT tests for West Nile, Hiv 1, HepB/C; 1 blood culture, a blood smear for parasites, and ~5 urine cultures.  All were negative.

I gave up on the creams and dont think it was dermatitis due to them as I had this before I started to use them.  My cbc showed elevated lymphocytes, and I have what appears to be Fordyce spots, which I did not have before the glans rash, so perhaps this is a form of HPV?    

I am hesitant to have a biopsy by the dermatologist and all the creams and pills are not helping with this rash.  I prefer to try some nonallopathic therapies before I get a glans biopsy, however do you think I should see another MD or specialist (ie-oncologist) about this, and is it possible this can be related to HIV or ARS?   Dermatologist did scrape it and tried to dye it - said it did not look fungal under the miscroscope and it did not respond to the dye.  

I am really worried here and the drs. have no idea, it could be some kind of inverse psoriasis or mild MRSA for all that I know.  Its persistence has me concerned and it has been going on for months now.

I appreciate your time and knowledge.  Best wishes for the holidays.

Hello Again, Sergio,
The skin on your glans penis still looks normal. All  your tests were normal, although I'm not sure how or why you had all of those tests done, since few if any could cause such skin variations. What are you worried about?  Your skin may change with time... sometimes it is temporary, sometimes not. There is no need for your worry. It is NOT MRSA or inverse psoriasis, neither of which are STDs. Skin conditions seem to persist since it may take 3 to 6 months or more for the skin to regenerate.  

Good luck!

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Mark P. Behar


Almost any question or concern about gay men's health issues, sexually transmitted infections, abnormal Pap smears, anal cytology (anal "Pap smears"), etc. There is no such thing as “d/d free” or “clean” (free of infection), so why do so many of us deceive ourselves into thinking that some people are indeed totally free from a potentially infectious disease, like HIV, herpes, hepatitis, syphilis, chlamydia, warts, gonorrhea, etc., just because they say so? Clinical laboratory tests are not perfect, and having a “negative” or “nonreactive” test does not mean that a person is free from infection. Perhaps at the moment the test was taken, the person was uninfected; or, perhaps, the test wasn’t sensitive enough to detect presence of the infection. There is really no way that anyone can determine that they are truly “disease free,” and there are over a hundred of infectious conditions that can be spread without your knowing anything. Rather than trying to “pre-screen” or “serosort” a potential sex-mate with deceptive questions that are impossible to know by today’s technologies, a wiser option may be to consider everyone infected with something, and either use appropriate protective measures (“safer sex”), or accept the responsibility and consequences of possibly “catching” something from someone who’s hotter than expected (pun intended!). There is much research that supports the contention that an HIV positive person reliably taking HIV medications, and having an undetectable viral load, presents a lower risk for transmission of HIV than people who may think or say they are HIV negative, but are not. Food for thought!


Family Practice PA since 1981; Volunteer Clinician for Brady East STD (BESTD) Clinic, Milwaukee, since 1977; answered STD questions submitted to their web site. Professionally lectured at national and regional Physician Assistant and Nurse Practitioner conferences, and at national gay & lesbian health conferences on topics including HIV/AIDS, herpes, hepatitis, STDs, human papilloma virus (the cause of venereal warts), abnormal Pap smears, gay and lesbian health issues, among others.

Co-Founder, Lesbian, Bisexual, & Gay Physician Assistant Caucus of the American Academy of Physician Assistants, Inc.; American Academy of Physician Assistants; Wisconsin Academy of Physician Assistants; National Co-Chair (2012-16), National Association of Black and White Men Together: A Gay, Multiracial Organization for All People (NABWMT)

Journal of the American Academy of Physician Assistants (JAPA) Q Visions, Quarterly Newsletter of the NABWMT

Bachelor's of Arts, 1972 (University of Wisconsin, Milwaukee, WI) Graduate Credits Experimental Psychology, 1972-75 (Tulane University, New Orleans, LA) Physician Assistant, Bachelor's of Science, 1981 (George Washington University, Washington, DC); Masters in Physician Assistant Studies, 2000 (University of Nebraska Medical Center, Omaha, NE)

Awards and Honors
Colposcopy Recognition Award (CRA), the American Association of Colposcopy and Cervical Pathology; Distinguished Fellow, Clinical Preceptor, American Academy of Physician Assistants; Fellow, Wisconsin Academy of Physician Assistants

Past/Present Clients
Brady East STD Clinic, Milwaukee, WI Milwaukee Health Services, Inc. (Martin Luther King Heritage Health Center), Dept. of Family Medicine and Early Intervention Program for HIV Infected Persons

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