Sexually Transmitted Diseases/Patches on Penis




Can you please suggest the condition from an attached image?


1. STD Panel after 40 days of protected oral, 30 seconds mouth-penis oral , all -ve
2. HIV, RT-PCR RNA-18 days, combo test 40 days, all -ve
3. Tried Azithromycin tab for 3 days with Soframycin cream. No improvement.

I am very worried, can you please reply at the earliest?


Dear Alex,
It looks like you have balanitis, the most common cause of which is a skin fungus, such as candida albicans. An topical antifungal cream such as terbinefine (Lamisil in the United States) may be effective. I'm not sure what the STD panel includes, but skin fungi are generally not thought of as STDs.  Sometimes balanitis can be caused by herpes.  The STD panel may have herpes antibody tests or DNA/PCR/NAAT tests designed to identify actual viral components-- I do not know what it covers.

HIV is also not one of the things that would cause this type of problem.

Soframycin is an antibiotic cream that is designed to kill certain bacterial infections. If your doctor thought you had a bacterial infection, that that is why it may have been prescribed.  Since it was ineffective, I suspect it was an incorrect guess.

One other thing. It appears that your penis is UNCIRCUMCISED.  Excessive friction from inadequate lubrication, as well as a medication induced irritation, or bathing soaps may also contribute to your symptoms.  

Good luck, and although annoying, this is nothing to freak out about.

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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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