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Help! Swelling, pus, and a scrip for Keflex...  

post #1 of 11
Thread Starter 
What a first post for this forum, eh? I'm a long time lurker here-- Frank, you've answered so many of my questions from day one! This time, though, I'm stumped.

I've read through the archives and the "sticky" thread on swollen foreskins, but I still have questions. Here's what's going on:

Not sure if this is related, but DS (18 months) has had a rotavirus-type illness the last several days; vomiting and low (or him) grade (102) fever, on top of a runny nose and general lethargy. I noticed coincidentally, his foreskin was looking slighty reddened and swollen, but nothing of concern.

Yesterday afternoon, while the other symptoms has lessened, upon removing his diaper for a change, I was greeted by a horrific sight. I can't call it foreskin swelling alone-- it was like his whole penis was rigid (but not an erection), red / purple, and easily TWICE the size of normal. The foreskin was tight, and seemed swollen itself. I noticed no discharge, but everything had swollen too tight. I immediately started epsom salt baths alternating with lavender / calendula baths. I also did "ye olde breastmilk squirt" trick, much to DS (and DH's) amusement. By bedtime, the swelling had reduced enough to where I didn't feel it was an emergency, and DS was not seeming to be in constant pain.

This morning, his entire penis was still red and swollen, but not so rigid-like (and again, I *swear* it was not erection rigidity), but I could see discharge. There was some smegma, but also some yellowish pus. I've continued all day with the soaks, and this afternoon we saw his ped, who while very no-circ friendly (his own son is intact), didn't seem to know much more about it than I did. He did say one infection does not Phimosis make, but that it WAS infected. He did not culture anything, but did give us a scrip for Keflex. He knows I feel very strongly about not using antibiotics, and said if it didn't clear up overnight, to start the course.

So, we've continued with baths, and I'm giving him a booster of Echinacea / goldenseal (as well as upping his probiotics and Vit. C). However, while it's not as awful and painful looking as yesterday, it's still inflamed and oozing a bit (although that has slowed, too.)

My questions (at last, you say!)-- what might you do? Could an infection left untreated with an antibiotic cause scarring and further complications? Are there other suggestions for helping to clear it up? And does this sound like a "routine" epithelial foreskin / glans seperation, or something worse?

The only thing that I could see as a complication is that at birth, my over-eager midwife (yes, midwife) retracted very gently, and DS's foreskin retracted. I remember her commenting how unusual it was that such a young baby would retract so easily (and I was sadly ignorant of such things, not to mention hemhorraging at the time!). Over the next few days, there was swelling and redness and even a slight fever, and I remember thinking she screwed up big time. But he recovered quickly, and I never thought about it again. Is it possible there's scar tissue there causing this problem?

Thanks so much for reading my veritable novel, and any advice you might have.
post #2 of 11
I don't have any really great advice, except to keep watching it and soaking it. If it looks like the red is traveling up the penis you might want to start the antibiotics. I know they totally suck, but sometimes they are warranted. You definitely don't want it to get too bad, because it could swell so much that he won't be able to pee. then you'll have a big problem (this happened to ds and it was reallly crappy, let me just put it that way) Just keep him on a good probiotic.

My ds used to get these quite a bit. Nobody ever retracted his foreskin. I think it was more a matter of him twiddling himself and a little dirt from his fingernails getting under his foreskin.

Poor little guy. I hope he feels better soon

**edited to add. I just read Frankly Speakings thread, and wow! what an informative post! We only had to give ds the antibiotics the one time (when he couldn't pee) Most of the time it did clear up by itself within 36 hours or so. It really makes sense that its a natural process in foreskin retraction because now that hes about 5, we really don't see them anymore**
post #3 of 11
Thread Starter 
Thanks mamamaya! I really appreciate you taking the time to wade through my issue. It's good to hear a BTDT story..

Things look marginally better this morning. I'm going to hold off on filling the scrip for a little longer... after a few more soaks.

Any other ideas?
post #4 of 11
Glad things look a little better
post #5 of 11
Quote:
Originally Posted by IslandMamma
Thanks mamamaya! I really appreciate you taking the time to wade through my issue. It's good to hear a BTDT story..

Things look marginally better this morning. I'm going to hold off on filling the scrip for a little longer... after a few more soaks.

Any other ideas?

My son had this happen once. I did a baking soda/lavender bath and by the next day it was fine.

The Epsom salt should work great too.

It seems to be clearing up with what you are doing.
post #6 of 11
One last thought, you could always try a dab of neosporin (sp?) before you try a systemic antibiotic.
post #7 of 11
I think your pediatrician gave some very good advise. I wonder if he's been reading my sticky at the top of the forum. :LOL However, he also put himself at a disadvantage in diagnosing the problem by not taking a swabbing for a culture and if it is in fact an infection, he can't possibly know for sure what the pathogen really is.

There is a possibility that your son's immune system is a little overwhelmed with the other infection and as soon as it regains control, it will take care of both of these all by itself. This could be a combination of both separation and some infection. At this point, it is still a little too early to tell and not being able to see it myself, a positive diagnosis is at least difficult.

I'll go along with the ped's recommendation. If it is separation trauma, it will show significant signs of improvement within 24 -36 hours. If it continues to improve after that, just wait and see if it completely clears up. If not, use the prescription and watch for improvement for another 36-48 hours. If it does not clear up, go back to the doctor and request a swabbing and culture and a prescription for the specific bacteria.

A single infection will not cause phimosis if it is promptly treated nor will a single retraction. Phimosis is the result of repeated and long term trauma. You have nothing to worry about here.

I know you are worried about your son but these things are not serious unless there is a problem urinating and as long as they are treated. Apparently, neither is the case here and you can relax about any phimosis or other problems. He is not even remotely close to that.




Frank
post #8 of 11
Thread Starter 
Update!

As of today, DS's penis and foreskin are TOTALLY back to normal, and he's running around like nothing ever happened.

Around noon yesterday, after a long soak, I noticed marked improvement-- less redness, way less swelling, and decided to keep up what we were doing. I also had been giving quite a bit of Goldenseal / Echinacea. In my gut I felt like this was resolving without the Keflex, and never filled the Scrip. Yay!

Frank, I did call and ask why he didn't culture, and why Keflex. His reason was that for just about any skin infection, Keflex is what he would prescribe, and he felt like swabbing was unneccesarily invasive. He also trusted me instinct to wait it out.

I'm so glad I did.

One other thing-- I've noticed that slightly raised firm band about 1/2" up the foreskin seems to have dissipated over all this-- could that be the result of the seperation? I'm of course not going to retract to find out, but there does seem to be a subtle change.

Thanks to everyone who chimed in with support and encouragement!
post #9 of 11
Just waving at Frank... I see you're posting same time as I am.
post #10 of 11
Quote:
Originally Posted by IslandMamma
Update!

As of today, DS's penis and foreskin are TOTALLY back to normal, and he's running around like nothing ever happened.
That's so good to hear. You'd be amazed how often we hear that. The human body has amazing restorative properties and this does seem to have been just some normal separation trauma. I know it was alarming and worrisome to you and I'm glad to hear it turned out so well. We've heard the same story many times and as a result, don't get too excited any more.


Quote:
Frank, I did call and ask why he didn't culture, and why Keflex. His reason was that for just about any skin infection, Keflex is what he would prescribe, and he felt like swabbing was unneccesarily invasive. He also trusted me instinct to wait it out.

I'm so glad I did.
A swabbing should not be invasive at all unless he was planning on retracting the foreskin to swab the inside surfaces and of course, that is not necessary or advisable. Just swabbing around the tip would be sufficient. Prescribing an antibiotic without knowing what pathogen is present is like going squirrel hunting at midnight

One other thing-- I've noticed that slightly raised firm band about 1/2" up the foreskin seems to have dissipated over all this-- could that be the result of the seperation? I'm of course not going to retract to find out, but there does seem to be a subtle change. [/quote]

There is a very good chance of it, at least partial separation at least. It's highly unlikely that the separation is complete and the separation is just one part of two in him becoming retractile. The preputial sphincter around the foreskin opening also has to become elastic as well.

Quote:
Thanks to everyone who chimed in with support and encouragement!
Your obvious happiness is thanks enough!




Frank
post #11 of 11
Hi Jennie!
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