A 24-year-old circumcised man presented with an ulcerative lesion on the penis which had been present for 3 days. He reported that the lesion had appeared after sexual intercourse with his girlfriend. He had been circumcised in childhood for religious reasons. Clinical examination revealed an ulcerative and crusted posthitis with multiple ulcers, penile oedema and bilateral inguinal lymphadenopathy (Fig. 1). The patient reported having fever and malaise. Cutaneous swabs for herpes simplex virus types 1 and 2, Treponema pallidum and Chlamydia trachomatis PCR were negative, whereas cutaneous swab for bacterial culture detected Streptococcus pyogenes and Staphylococcus aureus. Serological tests for syphilis, HIV and hepatitis C virus were negative. Systemic therapy with ceftriaxone, 1 g i.m. for 5 days, was prescribed, which resulted in improvement in the ulcerative lesions and general symptoms, but hard penile oedema was still present.The patient denied any aberrant sexual activity or other sexual practices, even upon further questioning. The personal history of the otherwise healthy patient was inconspicuous. Fig. 1. Ulcerative and crusted posthitis with multiple ulcers and penile oedema.
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Advances in dermatology and venereology