Inflammation and Lesions on the Glans: A Urology Perspective

Inflammation of the glans or balanitis?

Hello, doctor.
I apologize for the lengthy explanation of my symptoms.
I have phimosis but can fully retract my foreskin.
Over two months ago, I noticed a "red linear mark" approximately 1.5 cm long and 0.2 cm wide in the coronal sulcus.
A week later, there was "a shiny area with transparent fluid" at the connection point with the foreskin.
I went to see a doctor, and after a blood test, the doctor diagnosed me with "Type 1 herpes." I was prescribed Sinquart Ointment and mupirocin ointment (topical antibiotic) as well as "Xinghui" Meikang cream, a comprehensive skin disorder treatment, and "Kexing" tablets to take.
During this period, the redness and swelling increased, even affecting the foreskin covering it.
A month later, I consulted another doctor at the same hospital, who said it did not look like "herpes" but rather "balanoposthitis." He prescribed antibiotics and recommended soaking my penis in Eudyn solution.
Three weeks later, the redness and swelling improved, leaving only slight redness.
The doctor said this was normal and would take one to two months to fully resolve.
However, during the antibiotic treatment, I noticed "a bump that looked like edema or a blister" about 0.1 cm on the previously swollen foreskin, which was "very painful to touch" and would slightly indent when pressed but would swell back up shortly after.
I observed it for several days, and aside from the pain, there were no significant changes, so I didn't pay much attention until the redness and swelling resolved, and I could no longer find any surface abnormalities.
1.
Is it possible for "balanoposthitis" to present with "a bump that looks like edema or a blister" that is painful to touch?
2.
I want to believe the second doctor who said it was just balanitis.
When I later asked the first doctor, he said he only suspected herpes initially, so it was just inflammation.
However, the presence of "a bump that looks like a blister and is painful to touch" makes me doubt that it is not herpes, as I have heard that this can be a symptom of herpes, and inflammation does not typically present this way.
3.
I understand that discussing this online cannot confirm a diagnosis, but I need to clarify one thing: is it possible for the first question? If it is not possible, I can confirm it is herpes.
4.
If it is herpes, I have heard that after an initial outbreak, subsequent outbreaks are not worse than the first, at most the same (correct?).
So, would it be that next time, I might only develop a small blister again?
5.
Now, nearly three months have passed.
Although the redness and swelling have improved, as the doctor said, it is just pigmentation, making it look slightly red, I have recently experienced mild stabbing pain near the urethral opening at the tip of the glans, along with the foreskin and the originally swollen coronal sulcus.
Upon careful examination, I cannot find any abnormalities.
The doctor said he does not know, but it's okay, yet I never experienced this before the redness and swelling.

Kuai feng le de ren, 30~39 year old female. Ask Date: 2009/05/03

Dr. Xu Weikai reply Urology

Hello,
1.
Is it possible for there to be a "swelling-like blister" in the red and swollen area of the glans that causes a "stinging" sensation when touched?
A: Yes, it is possible.
2.
I really want to believe what the second doctor said is just glans inflammation, because later I asked the first doctor, and after reviewing the second doctor's report, he said it was only a suspicion that I had inflammation.
However, the presence of a "blister-like bump that stings when touched" makes me doubt it could be herpes, as I have heard that this is a symptom of herpes, and inflammation typically does not present this way.

A: Glans inflammation and balanitis are general terms that encompass various causes, including bacteria, fungi, viruses, and chemical irritants.
Herpes is also one of the factors contributing to glans and balanitis.
The formation of blisters is generally most often caused by herpes.
3.
I understand that discussing online cannot definitively diagnose a condition, but I need to confirm one thing: is there a possibility regarding the first question? If not, I can conclude it is herpes.

A: In Taiwan, over 80% of people have been infected with herpes, and the carrier rate is very high.
Generally, no special treatment is needed, as the immune system can manage it.
The virus typically remains dormant in the body and only becomes active when immunity decreases.
After treatment, it hides again in the body and can reactivate when the body weakens; it is usually not completely eradicated.
4.
If it is herpes, I have heard that after an outbreak, the next occurrence will not be more severe than the previous one, at most the same (is that correct?).
So, will I only develop a small blister next time?
A: As mentioned in the third point, each outbreak depends on the body's immune response.
If the immune system is weak, more lesions may appear.
5.
It has been almost three months now.
Although the redness and swelling have improved, as the doctor said, it is now just pigmentation, which makes it look a bit red.
However, I often feel slight stinging near the urethral opening at the tip of the glans, along with the previously swollen corona, and upon careful examination, I cannot find any abnormalities.
The doctor said he doesn't know, but it's okay.
However, I never experienced this stinging before the redness and swelling.

A: Sometimes, this may be due to excessive cleaning.
I recommend not using soap or hot water to clean the glans and foreskin, as this can easily lead to irritant inflammatory reactions.
Generally, cleaning with cool water is sufficient.

If there are any unclear points, feel free to ask again for further discussion.

Sincerely,
Director of Urology, Taitung Hospital, Department of Health, Executive Yuan
Xu Weikai

Reply Date: 2009/05/03

More Info

Understanding inflammation and lesions on the glans is crucial for diagnosing and managing urological conditions effectively. Based on your detailed description, it appears that you have experienced a series of symptoms that may be indicative of a few different conditions, including balanitis (inflammation of the glans) and possibly herpes simplex virus (HSV) infection. Let’s address your concerns systematically.

1. Possibility of a "water-like" bump during balanitis: It is indeed possible for a condition like balanitis to present with lesions or bumps that may resemble blisters or edema. Inflammation can lead to the formation of vesicles, which can be painful or tender to touch. These lesions can occur due to irritation, infection, or even allergic reactions to topical medications. The "water-like" bump you described could be a result of localized edema or a vesicular lesion due to the inflammatory process.

2. Differentiating between balanitis and herpes: The second physician's diagnosis of balanitis seems plausible, especially if the treatment with antibiotics and topical agents led to improvement. However, the presence of a painful bump raises the question of whether it could be a herpetic lesion. Herpes lesions typically present as painful vesicles that can rupture and crust over. If the bump you experienced was indeed painful and resembled a blister, it could warrant further investigation for HSV, especially if there is a history of similar lesions or if you have had unprotected sexual contact.

3. Concerns about recurrent herpes outbreaks: If you were to have a herpes infection, it is generally true that subsequent outbreaks may be less severe than the initial episode. However, this can vary significantly among individuals. Some may experience mild symptoms, while others may have more pronounced outbreaks. It’s essential to monitor any recurrent symptoms closely and consult with a healthcare provider for appropriate management.

4. Current symptoms and ongoing discomfort: The mild pain you are experiencing near the urethral opening and the glans could be due to residual inflammation or irritation from the previous infection. It’s not uncommon for sensitivity to persist even after the visible signs of inflammation have resolved. If the discomfort continues or worsens, it would be prudent to revisit your healthcare provider for further evaluation. They may consider additional diagnostic tests, such as a swab of the area to rule out any persistent infection or other underlying conditions.

5. Management and follow-up: Given your history of symptoms and treatments, it is advisable to maintain regular follow-ups with your urologist. They can provide tailored advice based on your specific situation, including potential lifestyle modifications, hygiene practices, and the use of topical treatments if necessary. If you have concerns about sexually transmitted infections, discussing safe practices and possibly screening for STIs would also be beneficial.

In conclusion, while your symptoms may align with balanitis, the presence of a painful bump warrants careful consideration of other potential causes, including herpes. Continuous monitoring and open communication with your healthcare provider are key to ensuring effective management of your condition. If symptoms persist or new ones arise, do not hesitate to seek further medical advice.

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