Hi happy no circ folks -
Well, at least I'm less panicked this time, but I've got that worried furrow in my brow for sure. How do I tell between fungal and bacterial symptoms?
My son will be 3 in Feb, and first had a severe severe balanitis/ posthitis in November, which resolved pretty quickly. We treated it with topical antifungal cream for 10 days total, though it was mostly gone in 3 - 4 days. That time, he first had redness around 3 pm, and by bedtime was insanely swollen, purplish, and then drained a good few ccs of smelly pus after we applied some antibiotic ointment. We started the antifungal cream the next day, and it slowly got better from there, and it's unclear if the antifungal really did the trick or whether it was self healing.
This time: he started with redness yesterday morning, and although it got worse during the day it hasn't (yet) progressed to the wildly awful state of last time. We've been applying the antifungal cream after every pee, and did a long hottish bath before bed. I notice a small amount of the same smelling pus dried in his underwear this am. Now, like last time, there's pain at the meatus with peeing (the peeing in water trick doesn't seem to help him.)
Both times: no inguinal involvement, no lymph nodes to speak of, no extension of redness to scrotum or torso, cheerful and mischievous when not peeing.
So, to distinguish between bacterial and fungal, I then think about likely causes - I can't think of any.
Fungal risks: We have an extremely low sugar diet (he thinks ak-maks are cookies, and diluted juice is a huge treat). He's been dry day and night and fully out of diapers since 18 months old (thanks, ec.) He's often naked at home, or just in underwear. I would think there'd be a risk for fungal if you sit around in a damp towel after bath, but in all weather, he throws off the towel before he's even dry and tears around the house for a while. He enjoys eating yogurt (plain) and chewing probiotic capsules straight.
Bacterial risks: Ummm. Well, he is more interested in his anus lately, and as he gets older he's more often out of sight so there could easily be some transference of bacteria that I don't catch. But I read that bacterial balanitis is usually staph/ strep and that's not usually found back there, I don't think. It doesn't seem like enterococcus could survive all that acidic pee, but I don't know. No sore throats in the past month at least.
Generally, and I don't know if this is pro- or con-
he hasn't had a lot of baths or showers in the past week, but we have been twice to the local public and highly chlorinated pool. This is a usual weekly event for us. Because he drained so thoroughly after the bath and bacitracin last time, I wonder if that's a better approach. But he only got that once, so presumably that didn't really do the trick...
I'd really appreciate any thoughts on how to distinguish between the two possible causes, or redirect me to a different forum...
I'm bummed and worried that... worried that I'll never learn to quit worrying. Anyway.
Thanks in advance.