Persistent Groin Odor After Treated Tinea Cruris
Direct Answer
This is almost certainly chronic bacterial overgrowth, most likely Corynebacterium species, not a fungal infection—your temporary response to chlorhexidine (an antibacterial) combined with complete lack of visible skin changes and failure to respond to antifungals confirms this diagnosis. 1
Why This Is Bacterial, Not Fungal
Your clinical presentation strongly indicates bacterial colonization rather than persistent fungal infection:
- Fungal infections cause visible symptoms (erythema, scaling, inflammation), which you completely lack 1
- The 24-hour response to chlorhexidine (an antibacterial agent) directly indicates bacterial overgrowth rather than fungal colonization 1
- Lack of response to clotrimazole rules out active candidiasis or dermatophyte infection 1
- Corynebacterium species produce volatile fatty acids that create the exact musty/sour/cheesy odor you describe in moist skin folds 1
Diagnostic Approach
Request a bacterial culture with speciation, specifically asking for Corynebacterium species identification, to confirm the causative organism 1. This is the only way to definitively identify what you're dealing with and guide targeted treatment if needed.
Root Cause: Microbiome Disruption
Your history reveals the likely cascade that created this problem:
- Prior antifungal overuse eliminated competing fungal flora, allowing bacterial overgrowth 1
- Chlorhexidine use perpetuated dysbiosis by preventing normal microbiome recovery 1
- Urine dribble provides ongoing moisture and substrate for bacterial growth in the groin fold 1
Treatment Strategy
Immediate Actions
Stop all antifungal treatments immediately—continued use worsens bacterial overgrowth by eliminating competing fungal flora 1
Reduce chlorhexidine to 2-3 times weekly maximum—daily use creates a "rebound" effect and prevents natural microbiome recovery 1
Microbiome Restoration
Apply probiotic spray (like the Gladskin you ordered) or plain yogurt with live cultures to actively restore the microbiome 1. This addresses the underlying dysbiosis rather than just suppressing bacteria.
Address Moisture Source
Manage urine dribble through pelvic floor physical therapy or absorbent pads to reduce moisture accumulation in the groin fold 1. This is critical—without controlling moisture, bacterial overgrowth will persist regardless of other interventions.
If Culture Confirms Bacterial Overgrowth
If bacterial culture identifies a specific pathogen requiring treatment, topical clindamycin applied twice daily to the affected area may be appropriate 2. However, this should only be used if culture confirms a pathogenic organism, not for normal skin flora.
Expected Timeline and Prognosis
Most cases of post-treatment microbiome disruption normalize within 2-4 months with appropriate management 1. Full resolution to pre-infection scent levels is achievable, but requires:
- Stopping the disrupting factors (excess chlorhexidine, antifungals)
- Addressing the moisture issue
- Allowing time for microbiome recovery
The key to preventing recurrence is managing the moisture issue—without this, the problem will return 1
Critical Pitfalls to Avoid
Never continue antifungal use—this worsens bacterial overgrowth by eliminating competing fungal flora 1
Never use daily chlorhexidine—this prevents natural microbiome recovery and creates rebound bacterial overgrowth 1
Don't expect instant results—microbiome restoration takes weeks to months, not days
Algorithm for Your Specific Situation
- Stop clotrimazole immediately 1
- Reduce chlorhexidine to 2-3x weekly only 1
- Start probiotic spray daily 1
- Address urine dribble (pelvic floor PT or absorbent pads) 1
- Request bacterial culture if no improvement in 4-6 weeks 1
- Wait 2-4 months for full microbiome normalization 1
The fact that you can physically swipe away the odor-causing material and that it returns only with moisture buildup further confirms this is bacterial biofilm formation in a disrupted microbiome, not an active infection requiring aggressive treatment.