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I have a male urology question that I have not been able to

fix. Seeing someone in 10...
I have a male urology question that I have not been able to fix. Seeing someone in 10 days, but don't wish to wait that long.In brief, pelvic pain and itching/scaling, crustiness/redness on the member.No STD, that is for sure. No prostatitis. The only "for sure" thing is a cyst that showed up on an MRI. a urologist said that could lead to pelvic pain. But makes no sense this would lead to crustiness, itching.I am trying to understand/fix this. Because it's annoying and distracting.Thanks!!!
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Answered in 54 minutes by:
9/14/2017
Muneeb Ali
Muneeb Ali, Emergency Medicine
Category: Urology
Satisfied Customers: 7,832
Experience: MBBS,MD,ECFMG certified. Have dealt with urological emergencies in the ER on a regular basis
Verified
Hi,
Welcome to Ja and thanks for this question. I just came online to see that you had been waiting for sometime so I'll quickly answer this question for you. Now from what you are describing it sounds like that you may have developed an infection over the penis, the crusitiness and the redness would occur even with infections which are not stds. Fungal infections can commonly cause this problem and this would be managed with the help of topical antibiotics fungal agents which would usually take care if this in most cases. Topical clortrimazole would be effective in most cases.
The other possibility is that you could have developed a bacterial infection which would be managed with topical antibiotics like bactriacin. If necessary it would be helpful to treat the problem with oral antibiotics.
If you have a picture that you can attach here that would be helpful.
Do you have anymore questions?
Please remember to leave a positive rating as that is how we are compensated for helping you today
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Customer reply replied 2 months ago
Hi, Dr. Muneeb Ali.Thanks for coming online. yes, I was waiting for a while. No, I don't have a picture, sorry. But you would not see much. It's more obvious by feel.So, how would I know? Do I need to have a urologist look at it? Can I simply buy these medications over the counter? I have a dermatological ointment called Ketoconazole 2% (it was given to me for the skin, not for this). But I tried it just now. Not sure if it helped.The questions I have is what exactly I should do. Buy these ointments and use them? How do I know if fungal or bacterial?Vladimir
Customer reply replied 2 months ago
if we can't handle this in just a few more short messages, then we can do the call. But I just wanted to know answers to the above. If best to call, ok.
Customer reply replied 2 months ago
oh, you cannot call? Why not? it's a US number.Anyway, just wanted to know:1) how can I tell which infection
2) which ointment to use
3) how to know i I should use antibiotics.Thanks!!!
The infection would be diagnosed with a simple swab over the penis which would be done in a doctors office
Try the clortrimazole cream that is available otc, it works better than ketoconazole
In order to use the antibiotics it is important to get tested and that would be determined by your doctor. The point here is that we need to see and feel the lesions along with tests to make a final diagnosis however usually it is a fungal infection which is present.
Regarding the call unfortunately I am in the hospital right now, no cell service that's why I can't call but we can continue here.
Do you have anymore questions?
Please remember to leave a positive rating as that is how we are compensated for helping you today
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Customer reply replied 2 months ago
I think it's ok. I will try to buy the cream tomorrow. Is it over the counter? When I put on ketoconazole, it got more dry and scaly.I did have many swabs and tests, but that was over two months ago. No infection then, at least not in the blood and urine.If I go to Urgent Care, can they determine it?That should be it for questions, thanks! :)So you have a shift at the hospital and doing this? Nice!Vladimir
they can determine this if need be but it is better to see your doctor in the morning for a detailed exam. Urgent care would be rushed in your case as it is not really an emergency. Try the clortrimazole but do get it evaluated by your doctor and yes the cream is available otc.
I do have a shift but given that I am an attending physician I just have to do my rounds while the residents can handle day to day. I have free time on my hands that's why I am here.
Do remember to leave a positive rating as that is how we are compensated for helping you today.
Muneeb Ali
Muneeb Ali, Emergency Medicine
Category: Urology
Satisfied Customers: 7,832
Experience: MBBS,MD,ECFMG certified. Have dealt with urological emergencies in the ER on a regular basis
Verified
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Customer reply replied 2 months ago
Ok!Will leave a rating now. I don't have a regular doctor. I meant Urgent care, not Emergency room:) That's the only way to see a doctor same day for me. I have an appointment with a urologist, but not for another 10 days.I just remembered, the urologist in Russia told me there was some one dose medication that killed any potential bacteria. I forgot to take it. Is there anything similar here?Thanks!Vladimir
Customer reply replied 2 months ago
Thanks, Dr.Ali!I did get the cream. seems to help. I also saw a doctor at Urgen Care (don't have a regular). They did a swab for fungus and a urine test for one - nothing. Can you recommend the name of specific tests for parasites/fungus? There must be one somewhere... I was told I had a cyst, but I don't think it's the only thing causing this.
The drug he was talking about would be Azithtomycin which would kill off most bacteria, it is a prescription only antibiotic.
Secondly if the swab test was negative then it can be another skin disease, this would need to be diagnosed by actually examining the lesion closely. Also the fungus which commonly infects the penile area is candida. It may not show up on swab tests in many cases, the best test is treating the problem if it disappears the diagnosis is confirmed.
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Customer reply replied 2 months ago
Oh, thank you!So should I do anything for Candida? I know a nutritional doctor who has good treatments for that. And would Aizthtomycin help or no? Well, the other doctor was in Russia, but I am sure it's a similar thing!Thanks!Vladimir
Well Azithtomycin would help a bacterial infection, the treatment I advised earlier the topical clortrimazole would help the candida an d if it does not then oral fluconazole would definitely help.
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Customer reply replied 2 months ago
Ok! So in what order should I do them, because I don't know which one it is...1) Clortrimazole
2) Should I ask for Azithtomycin at the same time or no?
3) When should I try the last one?and thank you againVladimir
Customer reply replied 2 months ago
Sorry for so many questions. I can pay more if possible (or ask another). But the itch/rash was only half the equation.The other half is constant pelvic pain (it's getting worse and radiating out). And I have no idea what it is. I was told I had a congenital cyst, but it has never come up before now. Do you have any ideas or suggestions? I am seeing someone in a week, but it seems like almost too long...Vladimir
An ultrasound would be helpful here and also looking into the prostate as a cause for the chronic pelvic pain would be advisable. In addition looking into urinary tract infection which means bladder issues should also be considered.
I can send you an additional services offer here which you accept for additional payment
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Customer reply replied 2 months ago
Thanks!I've had my prostate checked. It's fine. Had an ultrasound. Had urine and blood tests. No infection. The only thing we know for sure is there is a cyst. And for that I have an appointment next week.For now I am good with answers. But you tell me if I owe you anything more and how much!

I have sent you the additional services offer.

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Customer reply replied 1 month ago
Dr. Ali,I have a few more questions. How do we do this? Should I just use the link above and ask my questions? Or start a brand new question? Your answers were good and to the point and helped, so I would like to continue with you.Thanks!Best,Vladimir

I have sent an offer which you can accept so we can continue here.

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Customer reply replied 1 month ago
Dr. Ali,Maybe the offer is too old. I tried to pay and it's not letting me. And it's not the card. Can you re-send it, please?vladimir

Unfortunately, i cant send it in, its not allowing me to send another offer. You may need to open up a new question, starting with FOR DR MUNEEB ALI ONLY! and we can discuss this there.

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Customer reply replied 1 month ago
all right!
Customer reply replied 16 days ago
Dr. Ali,I just placed a new question and asked for you. Please pick it up!!Vladimir
Customer reply replied 16 days ago
Did you see my questions and that I asked for you?If that does not work, I can try to do more Q and A time again
Customer reply replied 16 days ago
I just did more Q and A time!! Can you, please, contact me? I am online now!Vladimir
Customer reply replied 16 days ago
Thanks, ***** *****!
Thanks for accepting the offer, I'm about to start my night teaching round for residents.... It will take me a couple of hours, leave your question here and I'll get to it as soon as i can
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Customer reply replied 16 days ago
I see. But I would like to have a conversation, if necessary. I mean if I need to clarify...So, maybe you remember our last conversation (it's above). And I used clotrimazole, it helped for a while, but then it began to make the skin very dry and scaly. For a while it got better, but now it still hurts.The main symptoms right now are: scaly/red scin/itching on the tip of the penis; some dripping and pain but in the anus/perlvis.I remember you suggested a possible fungal infection. it seems MDs don't know how to test for it. I went to a urologist and he found nothing wrong, but said that if the pains continue, since I had uroplasma a year ago and only took anti-biotics for 6 days, he recommends a full course for 1.5 months.I then wrote a naturopath I used to see in LA (since you mentioned fungus and he works with that) and asked him what to do. He prescribed some blood and urine tests (but I haven't done those yet). But he said the exact opposite: he said if it IS a fungal infection, then ANTI-biotics would only make it worse and I need to do an anti-fungal diet and take pro-biotics.So I am a bit confused about what to do. Just know I would like to do something effective!Thanks in advance!Vladimir

Thanks for this question,

Actually if it is a fungal infection then it can be tested for with the help of fungal swab and culture, or even a skin biopsy would be ab;le to diagnose the problem. Secondly, if all infections including bacterial and fungal are ruled out then i would consider other issues . First the inflammation at the tip of the penis is known as balanitis and this can be due to infections usually and that is why i would like to rule both of them out. Secondly, If the clortrimazole does not help as i said earlier i would go for fluconazole oral, which can be used for 4-6 weeks at a dose of 150 mg once weekly which should help in most cases.

If all infections are ruled out then we an consider balanitis xerotica obliterans. This is a condition in which there is inflammation of the tip of the penis due to autoimmune issues. It can cause symptoms like,

  • Pruritus

  • Burning

  • Hypoesthesia of the glans penis

  • Dysuria

  • Painful erection with altered sexual function

  • Decrease in urinary force or stream caliber

  • Urethritis with or without discharge

This can be diagnosed on a skin biopsy and then can be treated with lasers, topical tacrolimus, topical steroids among other options.

My suggestion is that get started on oral fluconazole, if your doctor wants to treat bacterial issues have him do that but WITH fluconazole and if after a month there is no improvement get a skin biopsy done.

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Customer reply replied 16 days ago
Thanks. Sorry, I don't know half these terms: pruritus, dysuria, urethritis, etc. I can study all of them, but can we do regular English, please? Clotrimazole helped for a little bit.My questions was: one doctor recommended antibiotics, because he said the uraplasma was probably not killed by 6 days of anti-biotics. You said it might be a fungul infenction. I went to the doctor, who did not know how to test for that. They did do a simple swam/urine test, but said it's not a 100% accurate. that left me hanging.The other doctor (naturopath) said he needs blood tests and if it IS a fungul infenction, then for sure NO antio-biotics. I have not done his test yet.I would like to get your opinion about the correctness of both statements. I DON'T have anyone who will treat this. I am not going to go back to the same urologist, because it took 4 weeks to get in and was not useful. So I will handle it myself with the help you the naturopath/you. But I have an anti-biotic prescription in my car (I can see what it is).Thanks!Vladimir

Dysuria - pain while urinating

Pruritus - itching

Urethritis - inflammation of the urine tube inside the penis

I believe since we are not sure as to which infection it can be, i would advise treating for both. yes antibiotics can worsen the fungal infection HOWEVER when you use oral fluconazole (an anti fungal agent) AT THE SAME TIME then you are also covering for any worsening of the fungal infection as well. Treating both at the same time will NOT result in worsening of either condition and we can be finally sure if this is an infection or not.

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Customer reply replied 16 days ago
Ok, does fluconazole have any side effects?How about doing one at a time?! ;)I can plan to do the lab tests this week and follow the naturopath's anti-fungul recommendations, but I could start the fluconazole right away. Is it prescription?! If that does not help, I could do anti-biotics.Thanks for the definitions!Do I need to accept anything to pay you?And what should my first step(s) be?Any fast way to alliviate the symptoms (whatever the reason)?Thanks,Vladimir
It does but it does not cause them in most patients.
I would recommend using both at the same time. As that would provide a faster way of getting better
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Customer reply replied 16 days ago
Thanks.Is fluconazole prescription or over the counter?But i know for sure anti-biotics are not good for you over a long period of time, right? So if it's not bacterial, is it not best to stay away from it first?Vladimir
It's prescription only. In some conditions we do treat with antibiotics for over 6 weeks and yes there are sometimes side effects but it is necessary in those cases.i gave treated several patients with long term antibiotics and they have not developed any side effects.
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Customer reply replied 16 days ago
ok, thanks! And I think it's already paid.

Yes it is, thank you.

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Customer reply replied 6 days ago
Hi, Dr. Ali!Update: I got the medicine (fluconazole). Didn't realize it was only 1-2 doses. I took one so far. Haven't seen a change, but maybe it takes time.I don't remember if I told you this: but when I did an MRI on the area (pelvis) they found a congenital cyst. The doctor I was seeing at the time (a lady) told me it could be the cause of the pain. But then I saw a male urologist and he said - no, it's nothing. Do you have an opinion? Should I see anyone else?Also, I remember you said to do both: ant-biotics and anti-fungus. But I am confused, because another doctor (a naturopath) I also trust said they will compete with one another. COuld I just first do one and then another?Is there any immediate remedy that would work? Because while the pain is not excruciating, it is very annoying - just constant pain in the pelvis between front and back...Thanks!Vladimir

I think both can be used at the same time and i have used both antibiotics/antifungals together without any issues.

Secondly the pain can be due to the cyst but i think it is less likely, i would first get the infection treated. Fluconazole does take time to work, i would take 4 doses, once weekly for a month and then evaluate whether it worked or not.

Unfortunately in your situation there is not an immediate remedy, it may take some time.

If all of the above are ruled out then balanitis xerotica obliterans should be considered as well as chronic pelvic pain syndrome.

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Customer reply replied 6 days ago
Thanks!I only got 2 doses from the doctor (it's prescription). Do I need to get more? And she said take one in 48 hours. But you think - wait a week?Ok, understood on the rest, thanks!Vladimir

Both methods of dosing are acceptable, some physicians prefer to dose every 48 hours, some wait a week. BOTH are equally effective so you can go ahead with the 48 hours dose and i think atleast 4 doses should be used.

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Customer reply replied 6 days ago
Got it, thank!
Customer reply replied 6 days ago
I mean "thanks"

You are welcome.

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Customer reply replied 6 days ago
can this fungus or bacterium cause any sort of pain? What I am feeling now is a pain through the whole region: from anus to penis and it's dull but radiating. It's weird. sorry to give you details.

Sometimes chronic infections can lead to the chronic pelvic pain syndrome which i talked about so yes it is possible.

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Customer reply replied 6 days ago
I see. So the reply is to do the above? Why does the other doctor say that antibiotics will harm the anti-fungal treatment? He says they promote funguses...

They do increase the risk of a fungal infection to occur HOWEVER that occurs if you are NOT being treated with an antifungal at the same time, if you are being treated with the anti fungal medication at the same time then the fungus would not grow. Antibiotics do have interactions with anti fungals and that is why if the antibiotic is started we would have to determine which one would be the ideal one, an antibiotic which does not react with the fluconazole.

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Customer reply replied 6 days ago
I see. I was prescribed one by the urologist. I already have that. If not that, I would have to go to another doctor to get a prescription. I can look and write you what it is...
Customer reply replied 6 days ago
it was doxycycline monohydrate that he prescribed. I have not taken yet
Customer reply replied 6 days ago
May I ask you, Dr. Ali: when does it become more urgent/"emergent"? Right now I can't sleep because of the pain and it's actually causing nausea. It has not been that strong before. Could it be that somehow fluconazole was the wrong move? because I took it yesterday and today it majorly hurts.Vladimir

Fluconazole would not cause worsening of the pain but it can cause nausea etc. Fluconazole does not cause worsening of the pain.

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Customer reply replied 6 days ago
All right, I understand. Thank you!

You are welcome.

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Customer reply replied 5 days ago
I will let you know what happens with it. Oh, last question: I had the MRI done without contrast. Would it help at all to do another with? Would that tell me more about the cyst?

It may if the cyst in vascular in nature which is unlikely.

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Customer reply replied 5 days ago
I don't know what that means:) As in, inside a blood vessel? On the picture is was right in the middle of either the prostate or the vessel from it... I can't recall. But I also don't know its nature unless tested, right? So should I do another test. do you think?

I dont believe so because if it was needed your doctors would have advised it.

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