Persistent Genital Itching Following Sexual Contact

Case at a Glance

A 27-year-old male presents with persistent genital itching and scaling lesions lasting 6 weeks following sexual contact, initially treated as presumed tinea cruris without resolution.

Patient's Story

The patient reports onset of genital itching approximately 6 weeks ago following sexual contact with a known partner on May 26th. He describes white, scaling patches with rough skin texture in the groin area. The symptoms have persisted despite topical antifungal treatment. The patient has a history of alcohol use and reports being overweight. He has had only two lifetime sexual partners and denies similar symptoms with his previous partner.

Initial Assessment

On June 13th, the patient contacted his healthcare provider's nursing staff describing persistent genital itching with white, scaling lesions. Based on the clinical description, the nurse provided a presumptive diagnosis of tinea cruris (jock itch) and recommended over-the-counter antifungal cream treatment.

The Diagnostic Journey

Despite 3 weeks of topical antifungal treatment, the patient's symptoms have not resolved. He reports concern about potential sexually transmitted infections, though his partner recently tested negative for STDs including herpes simplex virus via blood testing. The patient expresses uncertainty about the reliability of HSV blood testing and notes the absence of vesicular lesions.

Final Diagnosis

Pending further evaluation at scheduled appointment on July 4th. Differential diagnosis includes refractory tinea cruris, contact dermatitis, or possible sexually transmitted infection requiring laboratory confirmation.

Treatment Plan

Continue current antifungal treatment until clinical evaluation. Scheduled for comprehensive dermatological and STI screening including HSV testing, fungal culture, and direct microscopy of skin scrapings. Patient education regarding proper genital hygiene and consideration of lifestyle factors affecting immune function.

Outcome and Follow-up

Patient scheduled for follow-up appointment for definitive diagnosis and treatment modification if current therapy proves ineffective. Emphasis on importance of laboratory testing for accurate diagnosis and appropriate treatment selection.