Prevalence and Clinical Manifestations of Penile Gonococcal Cutaneous and Accessory Gland Infections in Men With Gonorrhea

Abstract

Background: No studies have focused on the prevalence and clinical manifestations of penile gonococcal cutaneous and accessory gland infections in men with gonorrhea. Methods:We enrolled patients with penile gonococcal cutaneous and accessory gland infections and patients with urethral gonorrhea from January 2014 to February 2020. Demographic data, occurrence sites, and manifestations of all patients were recorded.Results: Fifty-one patients with penile gonococcal cutaneous and accessory gland infections were observed among 1994 (2.6%; 95% confidence interval, 1.9%-3.4%) patients with urethral or penile gonorrhea. Lesions were present at the external urethral orifice in 22 (43%) patients, at the glans in 11 (21%), in the side of the frenulum of the prepuce in 7 (14%), in the penile raphe in 5 (10%), in the inner plate of the prepuce in 1 (2%), in the external urethral orifice and side of the frenulum of the prepuce in 3 (6%), and in the glans and side of the frenulum of the prepuce in 2 (4%). The lesions manifested as sinus-like lesions in 22 (43%) patients, abscesses in 14 (27%), nodules in 10 (20%), pustules in 3 (6%), nodules with sinus tracts in 1 (2%), and ulcers in 1 (2%).Conclusions: Penile gonococcal cutaneous and accessory gland infections in men probably are more common than previously understood. They mainly involve the paraurethral duct, glans, Tyson's gland, and penile raphe. Lesions mainly present as sinus-like lesions, abscesses, and nodules.

Clinical Study on Gonococcal Infection of the Penile Raphe

“…Research has shown that gonococcal infections of the cutaneous and accessory structures of the penis mainly involve the paraurethral duct, glans, Tyson’s gland, and penile raphe. Lesions mainly present as sinus-like lesions, abscesses, and nodules [3]. Gonococcal infections of the cutaneous and accessory structures of the penis are substantially more common than previously believed [4].…”

Gonococcal Infection of Penile Skin and Accessory Structures

“…In this issue, they report that penile cutaneous and accessory structure gonococcal infections occurred in 46 (2.3%) of 1989 men with urethral gonorrhea in their clinic over 6 years, from 2014 to 2020. 11 Five more men presented with such manifestations without urethral infection, bringing the prevalence to 2.6% (95% confidence interval, 1.9%-3.4%) of 1994 men with penile gonorrhea. This surprisingly high frequency does not accord with my clinical experience or that of 12 gonorrhea experts on 3 continents who responded to an informal e-mail poll.…”

“…12 The observed duration before care is consistent with the authors' previously reported experience, 10 and in the current report, they speculate about this potential contribution. 11 However, it seems unlikely that delayed care alone is responsible; the median time to clinic attendance is not reported, but probably many men attended for care within a week.…”

“…The association of paraurethral gland infection with "redundant" foreskin 10 raises questions about circumcision itself, as does the subpreputial location of many extraurethral infections. 11 Circumcision status is not mentioned, but probably most if not all of the reported patients were uncircumcised, as for >95% of Chinese males, 13 and retention of infectious exudate in the preputial sac is a plausible determinant of cutaneous or accessory gland infections located there. This in turn could interact with prolonged time before diagnosis and treatment.…”

“…10 In the present report, the incubation period-the interval from sexual exposure to symptom onset-was typical for uncomplicated gonococcal urethritis (mean ± SD, 5.2 ± 1.9 days), but time to clinical presentation (9.2 ± 8.3 days; range, 2-60 days) was longer than expected in industrialized countries. 11 In Melbourne, for example, men with gonococcal urethritis attend for care 5.6 ± 6.0 days (range, 1-30 days) after symptom onset. 12 The observed duration before care is consistent with the authors' previously reported experience, 10 and in the current report, they speculate about this potential contribution.…”