Iesions since 3months mild irritation, on itching,no pain. Married male 30y ,wife is not affected as patient said. dd &tt pl.

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Dr.Sandeep, Multiple white scaly patches on genetalia since 3 months. No pain and mild irritation and itching may be CANDIDAL BALANOPOSTHITIS . Here partner have not necessary to exhibit any symptomatology. She might be sufferer of MONILIASIS, common problem in the married women without symptomatology . First check his blood glucose levels. Because this is common in diabetic patients. Differential diagnosis Bowen' s disease Lichen Sclerosus Irritant contact dermatitis Erythroplasia pf Queyrat

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The diagnosis is written on its face- candidal balanoposthitis. No DD or invagive investigations not necessary. The wife factor- The wife is not effected means , the pt contacted it from his sexual encounter extramaritally, provided he is not diabetic himself. That the wife is not effected could be because he is avoiding her, otherwise he could not authenticate in her abscence and on her behalf. Taking the pt and putting the suggestions b 4 him brings out the whole story. How I confidently say is the study of psychology of STD pts over decades. Most of my conjenctures r 100% accepted.If not I threaten that hiding facts may lead to wrong diagnosis which is just enough for confession from even a hard core lier. Big or small his position socially, the psychology of an STD PT is same... so no rxceptions. Another inferred fact from wife not being affected is that the present sexual encounter is necessitated by her abscence, possibly away on brief trip or lonver trip on account of pregnancy - with no chance of satisfying the sexual hunger of the hubby and hubby knows it too well. When I say hubby , honest and who show fidility r exempted. The greatest temotation in life for a sexually active person is the sex. Rhishi Viswamitra even was no wxemption to this 'burnig desire or 'the desire that burns'. So better be rude than being nice if u wañt a colloborative history for ur diagnosis. Most of the hubbies pray that STD and sexual encounters out of wedlock are not to be made open b 4 the wife when she is insistedupon to be examined in case he does not admit exposure or not a diabetic. One concession I give is that I will treat him alone leaving her consort if 1) if he abstains from sex with her till he is declared currd. 2) after the treatment is decared over and subsequently the condition recurrs. The second is oroof enough that the patner is infect which precludes any ' ostentatious and emberassing exm". Both patners r treated this time simultaneously. All this is avoidable, if pt is willing his patner b to be treated irrespective of whether infected or not ( treatment on epidemiolgical basis- the thumb rule in STD). both r treated simultaniously. All this is to say that 'AT NO COST THE PATNER/ WIFE SHOULD NOT BE LEFT UNTREATED BADING ON THE " COCK AND BULL STORIES " OF THE MALE PATNER. I AM REGID ABOUT IT AS THERE IS EXCUSE OF TREATING WIFE WHOSE STATUS IS NOT KNOWN ON EPIDIMIOLOGICAL GROUNDS ( SHOULD BE SO TECARDED IN CASE SHEET) IS BOTH ETHICAL AND CORRECT FROM PUBLIC HEALTH POINT OF VIEW. STDs r 'contacted Naked'. Should we shun away from discussing the " naked truths"? " In theguise of decency" ?...

Since wife is not effected .SO Carcinoma in situ called Bowen's disease when shaft is involved and erythroplasia of Queryat when glans penis is involved should be kept in mind . A Biopsy is indicated. If it is present a topical 5 FU cream,CO2 laser ablation or surgical excision recommended. However, common things should be first possibility, most likely CANDIDAL BALANOPOSTHITIS .

Candidal balanoposthitis, check past history of sexual contact or extramarital contact , diabetes to be rule out, gyanic exam of wife is to be done before starting treatment,condom material allergy maybe possible

Candidal Balanoposthitis

? BALANOPOSTHITIS..

@Dr. Rajan N. Iyer sir It is a case of Balanoposthitis (candidial)

Genital CANDIDIASIS with balanoposthitis @Dr. P.kishore Kumar @Dr. M V Subramanyam @Dr. Avitus John Raakesh Prasad @Dr. Ashok Avachat

CANDIDAL BALANOPROSTHITIS.

Candideal balanoposthitis, check for immunocompromise.

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