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Genital Papules in an Adult Male

 


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Am Fam Physician. 2016 Jul 15;94(2):140-142.

A 43-year-old man presented with a one-week history of multiple weeping papules on his penis and scrotum. The lesions were not painful, and he had no other symptoms. He had no relevant medical history, including human immunodeficiency virus infection, but he had had unprotected sexual encounters with multiple women over the previous three months.

Physical examination revealed more than 50 firm, moist, pink papules on the scrotum and penile shaft (Figure 1). The lesions were nontender, smooth, and flat-topped. The patient had bilateral inguinal lymphadenopathy. The remainder of the examination was normal. A rapid human immunodeficiency virus infection test was negative. A biopsy was performed for further evaluation.


Figure 1.

Question

Based on the patient's history and physical examination findings, which one of the following is the most likely diagnosis?

A. Chancroid.

B. Condyloma acuminatum.

C. Condyloma latum.

D. Granuloma inguinale.

E. Lymphogranuloma venereum.

Author disclosure: No relevant financial affiliations.

Address correspondence to Victoria R. Sharon, MD, DTMH, at vsharon@ucdavis.edu. Reprints are not available from the authors.

REFERENCES

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1. Singh AE, Romanowski B. Syphilis: review with emphasis on clinical, epidemiologic, and some biologic features. Clin Microbiol Rev. 1999;12(2):187–209....

2. Handsfield H. Syphilis. In: Color Atlas and Synopsis of Sexually Transmitted Diseases. 2nd ed. New York, NY: McGraw-Hill; 2001:34.

3. Golden MR, Marra CM, Holmes KK. Update on syphilis: resurgence of an old problem. JAMA. 2003;290(11):1510–1514.

4. Centers for Disease Control and Prevention. 2015 sexually transmitted diseases treatment guidelines. Syphilis. http://www.cdc.gov/std/tg2015/syphilis.htm. Accessed Janaury 31, 2016.

5. Lewis DA. Chancroid: clinical manifestations, diagnosis, and management. Sex Transm Infect. 2003;79(1):68–71.

6. Chang GJ, Welton ML. Human papillomavirus, condylomata acuminata, and anal neoplasia. Clin Colon Rectal Surg. 2004;17(4):221–230.

7. Bezerra SM, Jardim MM, Silva VB. Granuloma inguinale (donovanosis). An Bras Dermatol. 2011;86(3):585–586.

8. Mabey D, Peeling RW. Lymphogranuloma venereum. Sex Transm Infect. 2002;78(2):90–92.

This series is coordinated by John E. Delzell Jr., MD, MSPH, Assistant Medical Editor.

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