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Which test should I take to diagnose fungal infection?

Q: I am a 28 years old man having fungal infection with some redness, inflammation, itching in the penile region, more specifically on the head of the penis and the other area below it. The doctor prescribed Flucanozole tablets for this. I also consulted a skin specialist and he diagnosed it to be candidiasis and gave me Nizral tablets with Candid cream to be applied on the affected area and told me not to take Fluconazole. Even after completing the 7 days of treatment, the red sores were still present and not much improvement was seen, although the pain and itching had gone. I visited the skin doctor again and he was also surprised to know that the redness was still there and changed my medication, which was for herpes. As per my understanding signs for herpes are generally blisters in the genital area with flu like symptoms, however I have never had any blisters there, it was just rashes and inflammation, which had got a little severe and resulted into certain red sores. What is the most reliable and comprehensive test that would help rule out the chances of herpes? What is the problem that I am having?

A:If till now you have not had any kind of sexual activity, it is very unlikely that you have genital herpes. It is true that the classical lesions of herpes are grouped tiny vesicles, but in a small number of atypical cases it may not be so. The clinical picture maybe non specific and go undetected. Further, serological test may be false positive and even false negative. Therefore in some cases diagnosis becomes evident during follow up. When in doubt, the diagnosis of fungus can be confirmed by KOH examination of the scrapes from an appropriate affected site. There are other conditions in which one can have red spots on the genitals.


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