balanitis, high fever, UTI?

[loraxc]

DS is 4 and uncirced and has never had any issues with his penis before. Yesterday he started running a high fever (104) and seeming quite ill--did not want to eat, mostly slept. Motrin improved him dramatically, but once it wore off, the fever went back up. Then he complained several times that his penis hurt, and he refused to eat and still seemed very sick, so thinking UTI, I brought him in. I had to see a ped I do not know to get an urgent care appt. His urine was tested, and they found ketones, protein, and white blood cells, but no infection per se. It is being sent off for a culture. DS is slightly retractible and the ped retracted him a small amount and immediately said it was balanitis and claimed it was very obvious. He also said DS had smegma on his penis and that this was a sign of poor hygiene. He gave us an RX for abx and abx cream and scolded me for not making sure he retracts in the bath.

Would balanitis cause this much fever and illness? Is it possible DS is going through separation trauma and this is a separate illness? I don't really know what to think. He is obviously quite sick. His penis tip did look red and irritated, but then I don't really know what it normally looks like, as I have only briefly seen him slightly retract in the past.

[A&A]

Call Marilyn Milos at nocirc.  (She's in California.)  She answers her phone personally and is very nice. 

[MCatLvrMom2A&X]

When I hear High fever with no other symptoms my first thought is a viral infection called Rosiola (not sure of the spelling) if it is the fever will break and a rash will appear. I didnt read anything in your post that screams foreskin infection. Pain when urinating can be as simple as seperation or a scratch on the foreskin. The Dr. is totally off base about retracting to clean being poor hygiene at your ds's age. Even if he did retract to clean daily smega is made daily so it would still be there.

[loraxc]

Well, he is much better after a few doeses of abx (or maybe it was just a matter of time). It is not roseola, which I also thought of--no rash after the fever broke. I do notice that his penis (I have been asking him to retract to whatever point is comfy--which is not very far--so we can put on the cream) is slightly less red...but not a LOT less red. He says it no longer hurts.

It will be interesting to get the results of the urine culture. My sense is that he probably had a UTI and not balanitis.

[MCatLvrMom2A&X]

I just wanted to mention that the normal color of the intact glans and inner foreskin is often a bright red/purple color. I am glad you are allowing him to do any manipulation instead of you doing it since he knows how far he can do it without pain.

[loraxc]

Update: DS did indeed have a UTI (caused by E. coli). The ped (not my usual one) continued to lecture me about "hygiene." However, on further research, I learned that a recent course of abx can upset the intestinal flora to make it likely that E coli will overgrow and be more like to cause a UTI. DS was indeed on abx for suspected pneumonia a couple of weeks before this happened (only his second time ever, and then of course that resulted in another course for the UTI...)

On reflection, it seems like "it's caused by poop getting on the penis" is a confusing explanation, As my husband pointed out--what about babies in diapers??? They certainly get a lot more poop on their penises than my pottytrained DS (who seems to have good hygiene as far as wiping--no skid marks, always washes his hands after he goes). I'm not convinced he did have balanitis, either; his penis really doesn't look much different than it did when he supposedly had it.