Dr Flo: Help for various pains

Dr Flo, I have been living with back pain for a couple of months. My problem started with low back pain and it has now extended to the hip joint and down to the knee through the femur muscles. The pain in the femur joint worsens at night. I'm not sure whether the back pain is related to the hip joint and to the knee pain, but all this pain has led to reduced mobility and it is disturbing. I have sought medical attention, but there has been no positive change. Kindly advise me. Kirui, Bomet
Dear Kirui,
The back pain, hip pain and knee pain are likely to be related. The most likely cause is a problem in the lower back that is affecting the sciatic nerve. The sciatic nerve is a big nerve that starts at the lower spine, and passes through the buttocks/pelvic area and down the leg, with branches going all the way to the toes. When the sciatic nerve is compressed, there will be pain, starting either in the lower back, or at the hip or buttocks, sometimes spreading down the leg, and to the toes.
The nerve can be compressed because of problems in the lower back, e.g. protrusion of the cushioning disc that is usually between the bones of the spine (disc herniation), or due to arthritis in the bones of the spine. The nerve can also be compressed by contractions of muscles as it passes through the pelvic area. Most of the time, these causes are not reversible, so the symptoms remain for a long time.
You need to see an orthopaedic specialist so that physical examination and some tests like X-rays and MRI scan can be done to find out the exact problem. Treatment includes medication for pain, both oral, and injections; stretching exercises, physiotherapy, massage, or surgery, if required. You also need to get a comfortable chair and to stand and stretch, or do some exercises after sitting for some time.

Dr Flo, I am 23 years old and for the last three months I have been having a sort of ulcer near the urethra opening. It's painless and there is no discharge. Urine tests have been done and revealed nothing. I have used mebo ointment and doxycycline which have not been helpful. Kindly advise me. PK
Dear PK,
A painless genital ulcer is usually caused by a sexually transmitted infection. The most common are syphilis and herpes simplex, but other possible infections include fungal infection, chancroid, lymphogranuloma venereum (LV) and donovanosis.
You may have other symptoms like pain when passing urine or swollen lymph nodes in the inguinal region. You may also have an ulcer resulting from sexual trauma or from other diseases that cause ulcer formation even in other body parts e.g. Behcet's syndrome and psoriasis.
A blood test for syphilis and herpes simplex virus, and culture tests can help arrive at a diagnosis. The treatment depends on the diagnosis e.g. antivirals for herpes and injections and oral antibiotics for the other infections. Twenty-one days of doxycycline is used to treat the LV and donovanosis.

Dr Flo, when I have sex with my girlfriend, the upper skin of my penis looks like it has burns and afterwards it looks ashy. What could be the issue? Joseph
Dear Joseph,
The skin changes could be due to a friction burn because of lack of adequate lubrication or due to rough intercourse. It may also be due to lice, scabies or fungal infection. Some STIs like syphilis and herpes can also cause skin lesions. Another possibility is an allergy to the latex in condoms or to a lubricant.
It is advisable to visit a doctor so that some tests can be done e.g. STI screening and examination of skin scrapings. Treatment will depend on the cause. Avoid friction burns by ensuring adequate lubrication and if an allergy is suspected, avoid the trigger.

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