Differential Diagnosis for Penile Secretions and Itching
- Single most likely diagnosis
- Smegma accumulation: The patient's complaint of a paste-like secretion on the penile shaft, combined with being uncircumcised and experiencing itching, particularly at night, points towards smegma accumulation. Smegma is a natural lubricant produced by the glands in the foreskin, but it can accumulate and cause irritation if not regularly cleaned, especially in uncircumcised males.
- Other Likely diagnoses
- Balanitis: This is an inflammation of the glans penis and can be caused by poor hygiene, infections (bacterial, fungal, or viral), or allergic reactions. The symptoms can include itching, redness, and discharge, which align with the patient's complaints.
- Contact dermatitis: This condition can result from an allergic reaction or irritation from soaps, lubricants, or other products used during masturbation. It could cause itching and possibly a rash on the penile shaft.
- Seborrheic dermatitis: Although more common on the scalp, seborrheic dermatitis can occur on other oily areas of the body, including the genital area, causing itching and a flaky discharge.
- Do Not Miss (ddxs that may not be likely, but would be deadly if missed.)
- Penile cancer: Although rare, penile cancer can present with a variety of symptoms including itching, discharge, and a lump or sore on the penis. It's more common in uncircumcised men with poor genital hygiene, making it a critical diagnosis not to miss.
- Sexually transmitted infections (STIs): Despite the patient reporting he is not currently sexually active, the possibility of an STI cannot be entirely ruled out without further history or testing. STIs like gonorrhea, chlamydia, or syphilis can cause penile discharge and itching.
- Rare diagnoses
- Lichen sclerosis: A rare condition that creates patchy, white skin that's thinner than normal. It can cause itching and discomfort, and if left untreated, can lead to scarring and tightening of the foreskin.
- Psoriasis: Although more commonly associated with skin lesions on other parts of the body, psoriasis can occur on the genital area, causing itching, redness, and possibly a discharge if the skin becomes infected.