Glans Issues: Persistent Symptoms and Diagnosis Challenges - Urology

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It sounds like you have been experiencing a complex and concerning set of symptoms related to your glans (the head of the penis) since the incident of oral sex last year. Your description includes a history of a small ulcer, a diagnosis of balanitis (inflammation of the glans), and the development of a persistent white, smooth area on the glans, along with changes in coloration and texture. You have also undergone multiple tests for sexually transmitted infections (STIs), all of which have returned negative results.

Firstly, it is important to understand that the symptoms you are experiencing can arise from a variety of causes, including infections, inflammatory conditions, and dermatological issues. The fact that you have been tested multiple times for STIs and have received negative results is reassuring, but it does not completely rule out other potential causes for your symptoms.

1. Balanitis: This is an inflammation of the glans that can be caused by irritants, infections (including yeast infections), or poor hygiene. The scarring you mentioned could be a result of the inflammation and healing process. If the inflammation was significant, it could lead to changes in the skin's appearance, such as the smooth white area you described.

2. Lichen Sclerosus: This is a chronic skin condition that can affect the genital area, leading to white patches and changes in skin texture. It is often misdiagnosed as other conditions, including infections. It can cause scarring and changes in pigmentation, and it is important to have a dermatologist evaluate this possibility.

3. Herpes Simplex Virus (HSV): While you mentioned that different doctors have suggested herpes, it is crucial to note that herpes can sometimes present atypically. If you have had negative tests for HSV, it may be worth discussing with your healthcare provider the possibility of a type-specific test, as standard tests may not always detect the virus, especially if there are no active lesions at the time of testing.

4. Other Dermatological Conditions: Conditions such as psoriasis or eczema can also cause changes in the skin of the glans. These conditions may not be sexually transmitted but can lead to similar symptoms.

5. Psychological Factors: Anxiety and stress related to sexual health can sometimes exacerbate physical symptoms or lead to heightened awareness of normal variations in skin appearance.

Given the persistence of your symptoms and the changes in your glans, it would be advisable to seek a referral to a dermatologist who specializes in genital skin conditions. They can perform a thorough examination and may suggest a biopsy if necessary to determine the exact nature of the white patch and any underlying conditions.

As for your question about whether to see a nephrologist (kidney specialist), it seems that your symptoms are more related to dermatological issues rather than kidney problems. Unless you have symptoms that suggest kidney involvement (such as changes in urination, swelling, or pain), it would be more appropriate to focus on dermatological evaluation.

In conclusion, while your STI tests have been negative, the ongoing symptoms warrant further investigation. A specialist's evaluation will help clarify the diagnosis and guide appropriate treatment. Remember, it is essential to communicate openly with your healthcare providers about your concerns and the impact these symptoms have on your quality of life.