Differential Diagnosis for Penile Complaints

The patient's presentation of penile pain, history of a groin abscess, and unprotected sex with a new partner, along with being uncircumcised and having whitish material near the base of the glans, suggests several potential diagnoses. These can be categorized as follows:

• Single Most Likely Diagnosis

  • Balanitis: This is an inflammation of the glans penis and is more common in uncircumcised men. The presence of whitish material near the base of the glans could indicate a fungal infection, such as candidiasis, which is a common cause of balanitis. The patient's symptoms and history make this the most likely diagnosis.

• Other Likely Diagnoses

  • Phimosis: This condition, where the foreskin cannot be fully retracted over the glans, can lead to poor hygiene, accumulation of smegma (which could be the whitish material), and increased risk of infections, including balanitis.
  • Sexually Transmitted Infections (STIs): Given the patient's history of unprotected sex with a new partner, STIs such as gonorrhea, chlamydia, or syphilis should be considered, especially if the pain is accompanied by other symptoms like discharge or lesions.
  • Cellulitis or Abscess of the Penis: Although the patient reports no drainage, the history of a groin abscess and current penile pain could suggest a localized infection.

• Do Not Miss Diagnoses

  • Penile Cancer: Although rare, penile cancer can present with pain, lesions, or discharge. It's more common in uncircumcised men and those with a history of poor genital hygiene.
  • Gangrene or Fournier's Gangrene: A severe, life-threatening condition characterized by necrotizing fasciitis of the genitalia. It's crucial to identify early due to its high mortality rate.

• Rare Diagnoses

  • Fixed Drug Eruption: A condition that can cause penile lesions or ulcers due to a drug reaction.
  • Behçet's Disease: A form of vasculitis that can cause genital ulcers, among other symptoms.
  • Lichen Sclerosus: A chronic inflammatory skin condition that can affect the genital area, leading to pain and scarring.

Immediate Management

Given the potential for infection and the need for further evaluation, initial management should include:

• Empirical antibiotic treatment for balanitis, considering coverage for both bacterial and fungal pathogens.
• STI screening to rule out sexually transmitted infections.
• Hygiene advice, including gentle cleaning of the genital area and retracting the foreskin for cleaning if possible.
• Follow-up for further evaluation and adjustment of treatment based on diagnostic findings.

It's essential to perform a thorough physical examination, take a detailed sexual history, and consider diagnostic tests (e.g., swabs for culture or PCR for STIs, biopsy if malignancy is suspected) to guide definitive management.