Sexually Transmitted Diseases/Red rash on penis head

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Hi Mark
I am 47 and married for over 24 years. My wife and I generally have sex atleast once a day so life has been good so far
About 2 months ago I noticed a red rash starting to appear and it is has slowly gotten worse
Around the same time we started using baby oil as a lubricant and soon found this can be painful as well so we swapped over to proper gel (vigel)
My wife first thought it may be stress related dry skin and so we put some moisturiser on the area to no real success
Our second step of personal diagnosis treatment was to use a condom and some anti fungul cream (clotrimazole) but neither seems to work as the area gets red after sex and isn't going away
We have now reduced sex to once a week and even then it is worrying me that I may be passing on something even though we are both very faithful to each other
Any help would be much appreciated
Our next step is a doctors visit if we can't get it under control
Thanks Willy

Answer
Hello Willy,
You didn't mention if you or your wife have any skin conditions (such as skin fungi such as yeast; eczema; seborrhea, psoriasis), or are using any medications or creams (other than the ones already mentioned). Silicone is a pretty safe and neural lubricant (unless once develops an allergy to it, which is uncommon). Baby oil is not a recommended lubricant, and water soluble lubricants frequently dry out. I'm not certain what is in vigel. You may have yeast infection that is resistant to clotrimazole, which is an older antifungal that has lost it's effectiveness. You are uncircumcised, and foreskins and uncirc'd penises are very susceptible to friction induced injuries, and fungi are opportunistic and can cause rashes such as what you have.

What I would do is try a different and stronger over-the-counter topical antifungal-- terbinefine (Lamisil), twice daily for a week.

Good luck!
--mark  

Sexually Transmitted Diseases

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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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