Photo Quiz

Genital Papules in an Adult Male


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.

 Enlarge     Print

Figure 1.

Figure 1.


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

A. Chancroid.

B. Condyloma acum

Author disclosure: No relevant financial affiliations.

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


show all references

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. 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.

A collection of Photo Quiz published in AFP is available at

Previously published Photo Quizzes are now featured in a mobile app. Get more information at

The editors of AFP welcome submissions for Photo Quiz. Guidelines for preparing and submitting a Photo Quiz manuscript can be found in the Authors' Guide at To be considered for publication, submissions must meet these guidelines. E-mail submissions to



Copyright © 2016 by the American Academy of Family Physicians.
This content is owned by the AAFP. A person viewing it online may make one printout of the material and may use that printout only for his or her personal, non-commercial reference. This material may not otherwise be downloaded, copied, printed, stored, transmitted or reproduced in any medium, whether now known or later invented, except as authorized in writing by the AAFP. Contact for copyright questions and/or permission requests.

Want to use this article elsewhere? Get Permissions

CME Quiz

More in AFP

Editor's Collections

Related Content

More in Pubmed


Jul 15, 2017

Access the latest issue of American Family Physician

Read the Issue

Email Alerts

Don't miss a single issue. Sign up for the free AFP email table of contents.

Sign Up Now

Navigate this Article