[ ARC forum 2 ]
Down to business, more
As an answer to: Re: Paul B, Down to business, more info about 7 yr old son with infections written by mermom at 24 Mar 2003 01:44:18:
OK, you've broken the continuity a little by posting anew, which is bad form on a forum because it makes it more difficult to refer to your previous posting, but that's a minor detail. 
1} No soap or bubble bath or other noxious substances (including antiseptics) used. That seems to be a major cause of "infections", so it's not going to be as easy to find other causes!
2} Can't see the end of his penis at all. Pretty tight then. This is why Jim quizzed you regarding a check (must be a blood test - fingerprick, but not urine) for diabetes. Uncommon in children though, unlikely not to be discovered over a five year period.
3} About 2-3 times a year/ it's pretty sudden, there is usually swelling and discharge by the time he indicates pain.
I am wondering whether bleeding has been part of the symptoms? Some possibility that this might relate to the progressive separation of synechiae, though on the other hand, if it is genuine infection (as against trauma, such as from separating synechiae) he may have developed adhesions, which complicates matters. I think you need to run the "balloon" test - if you have not already. It might even be therapeutic.
The thing about having a completely non-retractile foreskin, is that it makes it very difficult for bacteria to get in, so infections should really be less likely. However there are exceptions to just about all things!
4} They do clear up their own, after about 1-3 days
So from this, we gather a number of things. Firstly, they could be no more than episodes where the foreskin is separating, piecemeal. This might produce soreness, some swelling, transient bleeding, and some weeping perhaps. If however he can "balloon" the foreskin completely (except for where the fraenulum is underneath, but the "balloon" should still be separate from the head), this is not likely. In fact, if there is indeed discharge associated with these episodes, this might even be quite beneficial in dislodging it and settling the episodes faster.
Again, there is little to suggest that these episodes are anything close to life-threatening. Some might query that there could be an associated urine infection - this would actually be quite difficult to assess with a non-retractile foreskin. While they are painful, they are nevertheless tolerable - as it would be if your daughter had them (and of course, daughters do suffer this at least as often). You have determined that between the options of no treatment and oral antibiotics, there is no or negligible actual difference just as there is none for other conditions such as the common cold or "flu", a sore throat or even an ear infection. Incidentally, an ear infection is probably the closest parallel to this condition - the problem is again the difficulty in clearing out the area - arguably worse for the ear.
My belief is that the causative agent in the absence of chemical (soap, antiseptics) irritation, is most likely to be "thrush", though streptococcus is next on the list. My favourite medications are therefore a "thrush" medication - the same sort of formulation as sold for vaginal use is obviously appropriate - and Zinc & Castor oil cream, used as nappy (diaper) cream.
I forgot to query - you made mention of the "foreskin/ glans" - have you a feeling as to exactly where the soreness is - the foreskin opening, the foreskin proper, or the glans?
It might be worth trying one of these two medications (and because it is relatively inert and most unlikely to irritate further, I suggest the Zinc & Castor oil cream) introduced under the foreskin by a small syringe, without a needle of course, just squirting a little through the foreskin opening: Pull foreskin back, touch but do not press Luer tip to opening, roll foreskin forward over Luer tip and hold it sealed, squirt a small amount in and get him to "milk" it around underneath. This can be repeated as necessary, perhaps before peeing, to reduce sting.
5} Only OTC steroids (hydrocortisone) suggested. Apparently this so-called "specialist" is completely ignorant of the subject, as hydrocortisone is quite unlikely to work. The studies (read them!) really never mention hydrocortisone as it is not expected to do anything. Of course, one might be lucky, but really, the reason hydrocortisone is "OTC" is that it specifically does not have the effect - skin thinning and softening - that is needed in this situation.
I have described previously the method, albeit with an adult approach, but it is really no different.
Look, the situation you have is that you have not identified an avoidable event which triggers off these episodes of "infection", and they are largely a "fait accompli" when you find them, but they settle themselves and there is probably no more residual harm than a sore throat (don't even last as long as tonsillitis) or an ear infection.
You could just let things lie, but you obviously don't like to and I sympathise entirely. I have given my best suggestion as to managing the acute events and although it sounds a little fiddly, I venture to say you may find it might works superbly, terminating the problem within hours. And of course, you can "practice" it (and teach him to do it himself) in advance, as the stuff is pretty harmless (of course: you use it on babies' bottoms) and does not sting!
Whilst some may say that a non-retracting foreskin doesn't matter until puberty and may be easier to manage then, I personally don't see it that way, and more to the point, in your case, active management - making the foreskin retractile so that he does this every time he pees and can observe the earliest signs of irritation and apply the cream himself - directly this time - is the way to go. (Indeed, in the meantime, he may actually find that knowing how to use the cream himself, as of course he can, and realising that it will settle the condition promptly, is going to encourage him to recognise the signs much earlier than fearing the worst and knowing nothing will help.)