Unusual presentation of a periurethral abscess following infection withNeisseria gonorrhoea

Abstract

We describe an unusual case of a male patient presenting with penile and testicular swelling following an unprotected and traumatic sexual encounter. It was suspected that an isolated penile injury occurred during intercourse; however, ultrasound imaging identified an intact tunical layer and right-sided epididymo-orchitis. Following screening for sexually transmitted infections (STIs), he was discharged with antibiotics and advice to attend the Sexual Health Centre for contact tracing. He represented with a periurethral abscess and an antimicrobial-resistant (AMR) strain of Neisseria gonorrhoea was identified. Appropriate antibiotic treatment was initiated. Examination-under-anaesthesia, following abscess drainage, revealed a contained collection with no urethral fistula; however, a flat urethral lesion was seen during urethroscopy. Repeat urethroscopy and biopsy of the lesion indicated polypoid urethritis. Periurethral abscess secondary to gonococcal urethritis is a rare complication, but one that we should be suspicious of, especially with the growing incidence of AMR-STIs.

Nongonococcal tysonitis

“…3,4 The inflammation of Tyson's glands is known as tysonitis and is an infrequent complication of urethritis due to the direct spread of the infection to parafrenular glands. 1,2,5 Clinically it presents with unilateral or bilateral tender swelling on either side of the frenulum. 2,6 The main cause of tysonitis is gonococcal infection but it can be caused by other bacteria such as Escherichia coli.…”