13 years
My son is itching where the penis starts. Like around the start of the penis it's really itching, it's not red or visible unless you scratch it. It might be a yeast infection, we've tried some creams.
Sep 28, 2014
A number of possible causes can explain the condition you are describing. These include (and I have to stress the fact that an accurate diagnosis requires that you be seen by a physician):
1- Lymphocoeles
These appear as palpable cord-like structure that can occur vertically or horizontally at the shaft of the penis. They are associated with friction and increased sexual activity. They most probably result from an inflammatory process caused by a thrombosed vessel or in association with some sexually transmissible infections (STIs) such as Neisseria gonorrhoea or syphilis. As such, STI screening may be necessary. The thrombosed vessel will usually spontaneously recanalise (reopen) and therefore the condition is self-limiting.
2- Warts
Penile warts(Condylomata acuminata) are irregular, rough lesions that can occur anywhere along the penile shaft, glans and prepuce; they can also arise from the meatus. Their size varies. Warts on the shaft of the penis or pubic area tend to be more indurated and dome shaped, whereas those under the prepuce or emerging from the urethra are softer and fronded. A smooth-looking wart may be difficult to differentiate from a skin tag or other normal structure. Warts are most commonly due to HPV infection, types 6 and 11 Treatment options f include cryotherapy, podophyllotoxin and imiquimod. All of these therapeutic options typically require multiple treatments over a number of weeks. Most cases of HPV recover spontaneously over 12–24 months, so you may also opt to have no treatment.
3-Molluscum contagiosum
Small papules with a central depression. They are caused by a member of the poxvirus family, molluscum contagiosum virus (MCV). In adults, it is sexually transmitted molluscum and may be seen on or near the genitals. The infection usually resolves over a few of months, but treatment with cryotherapy is often recommended to prevent the spread of MCV to others.
4-Folliculitis
Inflammation of the hair follicles, frequently seen at the base of the penis. A pustule around the hair follicle is seen, it is frequently itchy and sometimes painful. This is to be distinguished from folliculitis from HSV, where vesicles due express a clear or straw coloured fluid; in regular folliculitis, if a lesion is aspirated, it produces thick purulent material (which may be blood stained). Herpes simplex virus may also be associated with a prodrome of malaise, fatigue and paresthesia (numbness/tingling) of the affected area. Molluscum contagiosum lesions is another casue occasionally confused with folliculitis, but there is sometimes a red halo. Folliculitis is often successfully managed with topical treatments and genital hygiene measures, but may need appropriate antimicrobial therapy if there is a surrounding cellulitis or a large number of lesions.
5-Primary syphilis
An early syphilis chancre may present as a non-ulcerated, button shaped lump on the penile skin. Chancres are often indurated and there is usually some sign of enlarged inflamed lymph nodes in the area. If syphilis si suspected, testing for it by PCR is recommended. Treatment is with oral antibiotics.
6-Scabies
Genital scabies are intensely itchy pink nodules. Patients usually have some sign of scabies elsewhere, such as the wrists, fingers and lower abdominal skin, which may include typical linear burrows. Treatment is with permethian cream.
1- Lymphocoeles
These appear as palpable cord-like structure that can occur vertically or horizontally at the shaft of the penis. They are associated with friction and increased sexual activity. They most probably result from an inflammatory process caused by a thrombosed vessel or in association with some sexually transmissible infections (STIs) such as Neisseria gonorrhoea or syphilis. As such, STI screening may be necessary. The thrombosed vessel will usually spontaneously recanalise (reopen) and therefore the condition is self-limiting.
2- Warts
Penile warts(Condylomata acuminata) are irregular, rough lesions that can occur anywhere along the penile shaft, glans and prepuce; they can also arise from the meatus. Their size varies. Warts on the shaft of the penis or pubic area tend to be more indurated and dome shaped, whereas those under the prepuce or emerging from the urethra are softer and fronded. A smooth-looking wart may be difficult to differentiate from a skin tag or other normal structure. Warts are most commonly due to HPV infection, types 6 and 11 Treatment options f include cryotherapy, podophyllotoxin and imiquimod. All of these therapeutic options typically require multiple treatments over a number of weeks. Most cases of HPV recover spontaneously over 12–24 months, so you may also opt to have no treatment.
3-Molluscum contagiosum
Small papules with a central depression. They are caused by a member of the poxvirus family, molluscum contagiosum virus (MCV). In adults, it is sexually transmitted molluscum and may be seen on or near the genitals. The infection usually resolves over a few of months, but treatment with cryotherapy is often recommended to prevent the spread of MCV to others.
4-Folliculitis
Inflammation of the hair follicles, frequently seen at the base of the penis. A pustule around the hair follicle is seen, it is frequently itchy and sometimes painful. This is to be distinguished from folliculitis from HSV, where vesicles due express a clear or straw coloured fluid; in regular folliculitis, if a lesion is aspirated, it produces thick purulent material (which may be blood stained). Herpes simplex virus may also be associated with a prodrome of malaise, fatigue and paresthesia (numbness/tingling) of the affected area. Molluscum contagiosum lesions is another casue occasionally confused with folliculitis, but there is sometimes a red halo. Folliculitis is often successfully managed with topical treatments and genital hygiene measures, but may need appropriate antimicrobial therapy if there is a surrounding cellulitis or a large number of lesions.
5-Primary syphilis
An early syphilis chancre may present as a non-ulcerated, button shaped lump on the penile skin. Chancres are often indurated and there is usually some sign of enlarged inflamed lymph nodes in the area. If syphilis si suspected, testing for it by PCR is recommended. Treatment is with oral antibiotics.
6-Scabies
Genital scabies are intensely itchy pink nodules. Patients usually have some sign of scabies elsewhere, such as the wrists, fingers and lower abdominal skin, which may include typical linear burrows. Treatment is with permethian cream.
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