Differential Diagnosis for a Painful Area on the Penis in an Uncircumcised Male with Negative HSV

• Single Most Likely Diagnosis
  • Balanitis: This is an inflammation of the glans penis and is common in uncircumcised males due to the warm, moist environment under the foreskin, which can foster bacterial or fungal growth. The symptoms can include pain, redness, and swelling, making it a likely diagnosis given the presentation.
• Other Likely Diagnoses
  • Yeast Infection (Candidiasis): As mentioned, yeast infections can occur on the penis, especially in uncircumcised men, due to the moist environment. Symptoms include a red, itchy rash and white patches, which could be painful.
  • Bacterial Balanoposthitis: This condition involves inflammation of both the glans penis (balanitis) and the foreskin (posthitis), often due to bacterial infection. It's common in uncircumcised males and can cause pain, discharge, and difficulty retracting the foreskin.
• Do Not Miss Diagnoses
  • Squamous Cell Carcinoma: Although rare, penile cancer can present with a painful lesion. It's crucial to consider this diagnosis, especially in high-risk individuals (e.g., those with a history of HPV infection, smoking, or poor genital hygiene), to ensure early detection and treatment.
  • Syphilis: The primary stage of syphilis can present with a single, painless chancre, but it's essential to consider syphilis in the differential diagnosis of any genital ulcer or lesion, regardless of pain, due to its potential for serious complications if left untreated.
• Rare Diagnoses
  • Fixed Drug Eruption: This is a rare condition that can cause one or more annular patches that are usually itchy or burning. It's a reaction to certain medications and can appear on the genital area, including the penis.
  • Lichen Sclerosus: A chronic inflammatory skin condition that can affect the genital area, leading to white, patchy skin that's thinner than normal. It can cause pain and discomfort, especially if the skin tears.