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Ask Dr. Arun Phophalia Your Own Question
Dr. Arun Phophalia
Dr. Arun Phophalia, Doctor (MD)
Category: Health
Satisfied Customers: 33110
Experience:  MBBS, MS (General Surgery), Fellowship in Sports Medicine
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Over the last three months I have had redness/irritation at

Customer Question

Over the last three months I have had redness/irritation at the meatus or opening of the penis. Sometimes it stings badly - especially at night. It does not hurt to pee, I have not had any form of discharge, and I have been tested for all STDs - even swab culture for both G & C. All negative. I was tested positive years ago for Herpes but I've never had any kind of outbreak w/ sores. I have seen both a dermatologist and urologist. All have said it's an irritation. The urologist tested my prostrate (even did PSA) and all seemed fine. I have been on two different antibiotics and several creams (bacteria/yeast/etc..). No change! Since I've left it alone w/ no creams - it is a little better. But it has not gone away. Any suggestions?
Submitted: 3 years ago.
Category: Health
Expert:  Dr. Arun Phophalia replied 3 years ago.

Greetings John.

I am sorry that your question was unanswered for long.

Was a mycobacterial culture done?

Were any antibiotics tried?

Dr. Arun

Customer: replied 3 years ago.

A culture was taken but more specifically for G & C. Both negative. That said, I have taken Fluconazole, Ciprofloxacin and then a course (10 days) of Doxycycline for bacteria. These didn't seem to relieve the symptoms (irritation/redness/stinging) at the opening.

Customer: replied 3 years ago.

Also several creams - Clotrimazole/Betamethasone, Nystatin nor Triamcinolone Acetonide) were not effective.

Expert:  Dr. Arun Phophalia replied 3 years ago.
Hello John,

There are couple of suggestions;

1) Your urologist may consider a prostate massage. This secretes fluid from the penis meatus which should be sent for the;

a) Ordinary culture called as pyogenic culture.
b) Mycobacterial culture.

2) A mycobacterial culture from the meatus directly.

These should be able to establish the diagnosis.

Please feel free for your follow up questions.

I would be happy to assist you further, if you need any more information.

Thanks for using JustAnswer.


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Customer: replied 3 years ago.

Should I assume if I am not having any kind of discharge, pain urinating or blood in urine that it would rule out Urethritis. Also, can eczema cause such an irritation at the meatus (opening of the penis)? Finally, can stress cause such an irritation?

Expert:  Dr. Arun Phophalia replied 3 years ago.
Hello John,

Stress is not likely to be responsible for the irritation. Eczema can be responsible for the meatus irritation; though it is likely to respond to betamethasone / steroid cream. Urethritis is not likely in your case, with no other symptom. Since bacterial and fungal infection is ruled out, an atypical infection like mycobacterial infection should be considered. Mycobacterium need a specific culture to establish the diagnosis.

It is privilege assisting you.

Dr. Arun
Customer: replied 3 years ago.

Even though I have never had a visible herpes outbreak (noticeable sores/blisters) can herpes cause the meatus or urethra to be irritated causing the redness irritation at the opening? I have taken valtrex and would think herpes wouldn't last three months. I also understand parasitic (e coli) can cause urethritis but again I have had no discharge or pain urinating - symptoms pointing to urethritis. Just irritation/redness and stinging feeling at the opening.



Expert:  Dr. Arun Phophalia replied 3 years ago.

I am sorry for the delay. I was offline (I had some surgeries to perform), so could not know about your reply. I apologize for your wait.

As you mentioned, herpes lesion would not last for 3 month, though it can involve the meatus occasionally. And than herpes lesion would respond to Valtrex. E. coli infection is unlikely to cause this kind of manifestation and would have detected by the culture test. An atypical bacterial infection thus is the likely cause.
Expert:  Dr. Arun Phophalia replied 3 years ago.
Hello John,

You rated the answer as poor service. I strive to do my best and provide utmost satisfaction for the customers coming to JustAnswer. I would be glad to answer your any further queries.

Best wishes and kindest regards
Customer: replied 3 years ago.

As you pointed out - your response time was very slow and not very detailed. It felt like short/quick answers. It felt like you wanted to end the session as quickly as possible.

Expert:  Dr. Arun Phophalia replied 3 years ago.

We many times are unable to be online for various reasons (like professional work etc). So some delay may happen. I really am sorry about it. But I never wanted the session to end quickly. I can understand you have a difficult medication question which has not responded. So other uncommon diagnosis should be thought of by your doctor. I wish you a very fast and early recovery.