Hey there!

Now, I don't usually do this sort of thing, but I just so happened to be reading up on the latest cancer immunotherapy literature, one thing led to another, 20 minutes of being ADHD at 3 AM later and I found your post.

I noticed you'd posted this concern recently, thoroughly appreciate your grammar, and both your username and story resonated with me; particularly because I too have only ever been with my current sexual partner, who was born in 1992 (I assume that might be the reason for the numbers in your username?) and who I - wait for it - gave a small red fungal rash to, on the tip of his glans, when I unknowingly had some vaginal thrush... Equally, my partner also suffered from a dry glans that could get quite sore and inflamed with sex and masturbation. 

I can wholeheartedly appreciate your frustration; how far progressed does a potentially cancerous lesion need to be before they even think to send a swab to microbiology to conclude fungus + do susceptibility testing, or refer you to a dermatologist who can spend 5 seconds looking at the rash with more specialist magnifiers? So much for all those adverts and education about getting early warning signs checked to save your life; yikes!

However, given your story and the reaction of your doctors, I feel, with some confidence (unfortunately 'some' is the best I can do without seeing or examining it myself), the rash you have isn't cancerous or anything particularly sinister...
 

Now, fungal infections are persistent and they are a pain. It's, unfortunately, not uncommon for 1 week's worth of Canesten to do next to nothing. Then, any break in between administration whilst you got your second prescription gives the fungal infection time to regrow. 

Next, antibiotics. Antibiotics destroy your normal commensal bacteria and this can exacerbate fungal infection. This can ensure its survival despite co-treatment with Daktarin.

Third, I'd not recommend continuing with the Canesten + hydrocortisone, as hydrocortisone is a steroid. If topical antifungals alone didn't work for you initially, adding steroids to the mix could potentially lower your chances of success due to the suppressive effect they have on the immune system.

I'd recommend going to your pharmacy and asking to purchase Clotrimazole (Clotrimazole is the active ingredient in Canesten, but scrap the brand name and it's a whole lot cheaper). If they can do 2% Clotrimazole, even better. Apply 3 times a day for 4 weeks. Does it disappear after that time? If so, great! But keep applying for 14 days after the disappearance. - Like I said, persistent!

If it doesn't disappear after that time I suggest returning to your doctor, explain explicitly you tried 4 weeks of 3-times-daily Clotrimazole, and specifically request a swab test with antifungal susceptibility testing. This is a quick, easy and cheap test.

If you want to go hardcore, you could also request a blood test be done to determine your levels of "IgA". IgA is a component of your immune system that is critical at fighting infection at mucous tissue; this includes your glans. If this is fungal, we want to know why your body isn't clearing the infection after 4 weeks continuous antifungal administration (unless susceptibility testing answers that for us...). 

If all this fails, ask for a referral to a dermatologist. A dermatologist would be the best specialist to see before an oncologist in this scenario, and they will very promptly refer you to an oncologist if they felt the need. 

I wish you the best of luck with all this. Hope things go well! x

Hi!

Thank you ever so much for taken the time out of your day for the reply, I really appreciate it. 

Sorry, I actually forgot to mention I was sent for a Full Blood Count on (FBC) on Wednesday. I'm not in the medical profession, so I'm unaware, but would a FBC indicate the levels of IgA?

I appreciate you've mentioned the infection could persist whilst between medications, but I haven't actually stopped application. I don't think there's been a day since this all started (aside from my initial noticing of it) that my glans haven't had some sort of antifungal cream applied. That's the reason for my concern really is that progress doesn't seem to be made. I am aware that the antibiotics could rid of good flora also helping the fungal to survive, but at 4 weeks in with fungal alone it was worth a shot from the doctor.

I'll look into what you mentioned with the Canesten HC. The GP has requested that if in two weeks time the symptoms persist I return. I imagine they'll still be here in two weeks time so in my next visit I'll bring up the swab stest with antifungal susceptibility. I also imagine that will be my visit that secures some sort of referral. In your opinion, would a urologist or dermatologist be better suited? Again, only because I'm not in the medial field and I'm unaware. I understand a dermatologist deals with issues of the skin but isn't a urologist's specialties the genital area?

Anyway, thank you again for your time and just to confirm, yes, 1992 is my birth year. 

Hey again!

Thanks for clarifying that you've not stopped applications since the appearance of the rash; that helps narrow things down.

A Full Blood Count, sadly, won't include testing for IgA. This is a much more specific test that doctors only order if they're concerned a patient has some sort of immunodeficiency or an autoimmune disease like coeliac disease.

Susceptibility testing to a) see if we can actually culture fungus from the rash and thus confirm or deny this diagnosis; b) Identify if this particular fungus has resistances to the topical medications you've been applying, and which medications will work, is a good course of action.

Though, given you've been trying antifungal treatment continuously for such a long period of time, I'm tempted to say we skip this and request to see a specialist. In this situation, I think a dermatologist is best suited because this is more a condition on the skin of your penis, more than it is a problem with your penis or urogenital tract as a whole organ.

It's entirely possible that this isn't fungal. If it isn't, I'm happy to say the chances of it being cancer are exceptionally slim given your age. Penile cancer accounts for only ~1% of all cancer diagnosis in the UK, and most incidences occur in men much over the age of 40. If fungal infection is negative, it's possibly another condition such as Lichen Sclerosis, Balanitis, or even Psoriasis. Balanitis, interestingly, can occur as a result of trauma or irritation. A factor these three all have in common is that they're correlated with stress, so if you have any current stress in your life then they can be exacerbated and persist. Definitely things to think about. 

These are all things a dermatologist will be able to test for. They may also take a small biopsy to confirm/deny diagnosis and also to test for cancer because you aren't wrong, a small patch of persistent inflammation is an early warning sign. But it is early, and it is also a sign of plenty of other things. 

You're definitely asking all the right questions, providing the right information, and have great self-awareness. You'll get to the bottom of this. :)