Sexually Transmitted Diseases/White penis

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Hello sir, I have a problem with my penis and I hope youcan help me as i am desperate. It's quite a long history and i will start with it, hoping that i can provide enough evidence...
All started about 1 year ago when i had balanitis candidoza. I tried in the first place with a cream and simple fluconazol for 2 weeks. Then I went to a medic and i treated it with Diflucan(fluconazol) and canesten cream and it disappeard after 1 week or so. Within 3 months appeard again and i used canesten for 3 days and it disappeard again. The thing is that now since 5 months ago appeard for the 3rd time and this time i tried with diflucan and canesten for 2 weeks ( no result), then i tried the same treatment one again for 1 week ( no result). After that i went to a medic in Belgium, as i was traveling in Europe and he just took a look and told me that it is lichen sclerosis and gave me dermovante steroids for 1 month and a half and nothing happened, appart that it was itching me so hard and it became kind of painful while using the cream. So after i went again he said that i have to circumsize. I can't accept it, because i looks identical with the balanitis that i had 1 year ago ( the skin looks like i kept it in water and got some cracks, it's always wet and it smells really bad despite rigurous hygiene, and it i pull down the skin and expose the raw penis to air while in erection it starts having white dry stuff which i can take away, like dandruff). The thing is that the medic didn't took any biopsy andjust cassualy said "circumsize". Is it possible to be still the same candidoza that got some resistence over time to diflucan? I ams sorry for my long story, I don't want to circumsize and i am looking for some hope...

Answer
Hello Dany,
Your first skin condition was an inflammation of the foreskin and possibly head (glans) of the penis, called balanitis.  The most common cause of this is a skin fungus known as candida.  Thus the term, "balanitis candidoza."  

Skin fungi are common culprits and what happens to you when you urinate kind of may continue the problem.  A drop or two of pee might be left behind, and the nitrogenous waste products in the urine in contact with the unkeratinized (moist skin of for foreskin) causes anerobic germs to colonize, causing the odor.  When showering or bathing, pull back foreskin, wet with water but no soap, and then pat dry as best you can.  When urinating, pull back foreskin, shake when done so no drops of urine are left over, and then zip up.  

You may try a new and stronger antifungal cream, such as terbinefine (Lamisil AF, but the active ingredient may be different in different countries-- look specifically for terbinefine), as the fungus may become resistant to the older antifungal creams you have been using.   Any time you have sex with someone else (oral, anal, vaginal) without condoms, you may be acquiring some of their fungi (as fungi are ever present!).  NOTE, that if you continue to get this condition, your doctor should be checking you for diabetes, as sugar in the urine (from uncontrolled diabetes) may also contribute to this condition's recurrence.

That's why you're being persuaded to have a circumcision.  Foreskins tend to promote such issues. Besides yeast and fungal infections, and paraphimosis, and penile cancer, it also may be allow faster entry of the HIV virus if it is present in your partner.  If it comes down to having it done, as them to do as minimal a circ as possible-- such as a "turtleneck" circ. just so the head is not in danger of being too constricted if phimosis occurs again.   

By the way, although the skin looks a little red and flaky, your penis otherwise looks fine.

Good luck!
--mark  

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Mark P. Behar

Expertise

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!

Experience

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.

Organizations
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)

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

Education/Credentials
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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