Infectious Penile Lesions

1. A 63-year-old man complains of a mildly painful and tender rash on his penis that has been there for almost two years. The patient is uncircumcised; when the foreskin is retracted, a bright red, erythematous, nonscaly, circumferential plaque is visible on the glans penis, spreading to the foreskin. He denies pain on urination, discharge, fever, malaise, arthralgias, and sexual contact outside of his marriage.

Diagnosis: Zoon balanitis is a benign condition that typically affects uncircumcised middle-aged to elderly men.^1,2 Worldwide prevalence among uncircumcised men is approximately 3%.² The etiology is unknown; it’s thought that this condition may be caused by friction, trauma, heat, lack of hygiene, exogenous or infectious agents, an IgE hypersensitivity, or a chronic infection with Mycobacterium smegmatis.^1,2

Typically, the appearance of the lesion precedes diagnosis by about one to 2 years.¹ The patient usually complains of mild pruritus and tenderness. Undergarments may be bloodstained.

The lesion associated with Zoon balanitis is a solitary, glistening, shiny, red-to-orange plaque of the glans penis or prepuce of an uncircumcised male. Pinpoint erythematous spots or “cayenne pepper spots” may also be associated with this condition.

For more information on this case, see “Erythematous penile lesion.” J Fam Pract. 2012;61(12):753-755.

2. A 21-year-old man presents with bumps on his penis. He admits to having unprotected sexual intercourse with more than six women in the past year. He is otherwise healthy.

Diagnosis: Genital warts are caused by human papillomavirus infection. The incubation period after exposure ranges from three weeks to eight months. Anogenital warts represent the most common viral sexually transmitted infection in the United States; there are approximately 1 million new cases of genital warts per year. Most infections are transient and clear up within two years, but some infections persist and recur.

The diagnosis is usually clinical; genital warts are typically asymptomatic and present as flesh-colored, exophytic lesions on the genitalia, including the penis, vulva, vagina, scrotum, perineum, and perianal skin. External warts can appear as small bumps, or they may be flat, verrucous, or pedunculated. Treatment options include cryotherapy and prescription imiquimod cream.

For more information on this case, see “Genital bumps.”

3. A 27-year-old man is worried that he may have contracted chlamydia. About five days ago, he experienced pain and a burning feeling with urination. Three days ago, a painful, growing lump near the head of his penis developed. The patient has a purulent urethral discharge and fluctuant, yellowish white, tender swelling on the left side of the frenulum. There are no ulcers, but there is a single 2-cm lymph node in the right inguinal area that is of normal consistency, mobile, nontender, and nonfluctuant.

Diagnosis: The clinical history was consistent with a diagnosis of gonococcal urethritis complicated by a periurethral gland abscess. The location of the swelling was most consistent with an abscess in the Tyson’s gland (also known as tysonitis). The Tyson’s (or preputial) glands of the penis are sebaceous-type glands on either side of the frenulum at the balanopreputial sulcus.¹ In women, an abscess of the periurethral Skene’s gland is an analogous gonorrheal complication.

The differential diagnosis of acute swelling on the penile shaft includes syphilis, chancroid, lymphogranuloma venereum, herpes simplex virus, Behçet’s syndrome, a drug reaction, erythema multiforme, Crohn’s disease, lichen planus, amebiasis, scabies, trauma, and cancer.

For more information on this case, see “Returning traveler with painful penile mass.” J Fam Pract. 2011 May;60(5):285-287.

4. A 32-year-old man presents with a week-long history of painful vesicles on the shaft of his penis associated with tender groin adenopathy. Two days ago, the vesicles broke and the pain worsened. The patient had similar lesions a year ago but did not seek medical care. He has had three different female sexual partners over the past two years but has no knowledge of them having any sores or diseases.

Diagnosis: Genital herpes presents with multiple transient, painful vesicles that appear on the penis, vulva, buttocks, perineum, vagina, or cervix. The vesicles break down and become ulcers that develop crusts while healing. Recurrences typically occur 2 to 3 times a year. The duration is shorter and less painful than in primary infections. The lesions often heal completely by 8 to 10 days.

Antiviral therapy is recommended for an initial genital herpes outbreak. Although systemic antiviral drugs can partially control the signs and symptoms of herpes episodes, they do not eradicate the latent virus.

For more information on this case, see “Painful vesicles on penis.”

1. A 63-year-old man complains of a mildly painful and tender rash on his penis that has been there for almost two years. The patient is uncircumcised; when the foreskin is retracted, a bright red, erythematous, nonscaly, circumferential plaque is visible on the glans penis, spreading to the foreskin. He denies pain on urination, discharge, fever, malaise, arthralgias, and sexual contact outside of his marriage.

Diagnosis: Zoon balanitis is a benign condition that typically affects uncircumcised middle-aged to elderly men.^1,2 Worldwide prevalence among uncircumcised men is approximately 3%.² The etiology is unknown; it’s thought that this condition may be caused by friction, trauma, heat, lack of hygiene, exogenous or infectious agents, an IgE hypersensitivity, or a chronic infection with Mycobacterium smegmatis.^1,2

Typically, the appearance of the lesion precedes diagnosis by about one to 2 years.¹ The patient usually complains of mild pruritus and tenderness. Undergarments may be bloodstained.

The lesion associated with Zoon balanitis is a solitary, glistening, shiny, red-to-orange plaque of the glans penis or prepuce of an uncircumcised male. Pinpoint erythematous spots or “cayenne pepper spots” may also be associated with this condition.

For more information on this case, see “Erythematous penile lesion.” J Fam Pract. 2012;61(12):753-755.

2. A 21-year-old man presents with bumps on his penis. He admits to having unprotected sexual intercourse with more than six women in the past year. He is otherwise healthy.

Diagnosis: Genital warts are caused by human papillomavirus infection. The incubation period after exposure ranges from three weeks to eight months. Anogenital warts represent the most common viral sexually transmitted infection in the United States; there are approximately 1 million new cases of genital warts per year. Most infections are transient and clear up within two years, but some infections persist and recur.

The diagnosis is usually clinical; genital warts are typically asymptomatic and present as flesh-colored, exophytic lesions on the genitalia, including the penis, vulva, vagina, scrotum, perineum, and perianal skin. External warts can appear as small bumps, or they may be flat, verrucous, or pedunculated. Treatment options include cryotherapy and prescription imiquimod cream.

For more information on this case, see “Genital bumps.”

3. A 27-year-old man is worried that he may have contracted chlamydia. About five days ago, he experienced pain and a burning feeling with urination. Three days ago, a painful, growing lump near the head of his penis developed. The patient has a purulent urethral discharge and fluctuant, yellowish white, tender swelling on the left side of the frenulum. There are no ulcers, but there is a single 2-cm lymph node in the right inguinal area that is of normal consistency, mobile, nontender, and nonfluctuant.

Diagnosis: The clinical history was consistent with a diagnosis of gonococcal urethritis complicated by a periurethral gland abscess. The location of the swelling was most consistent with an abscess in the Tyson’s gland (also known as tysonitis). The Tyson’s (or preputial) glands of the penis are sebaceous-type glands on either side of the frenulum at the balanopreputial sulcus.¹ In women, an abscess of the periurethral Skene’s gland is an analogous gonorrheal complication.

The differential diagnosis of acute swelling on the penile shaft includes syphilis, chancroid, lymphogranuloma venereum, herpes simplex virus, Behçet’s syndrome, a drug reaction, erythema multiforme, Crohn’s disease, lichen planus, amebiasis, scabies, trauma, and cancer.

For more information on this case, see “Returning traveler with painful penile mass.” J Fam Pract. 2011 May;60(5):285-287.

4. A 32-year-old man presents with a week-long history of painful vesicles on the shaft of his penis associated with tender groin adenopathy. Two days ago, the vesicles broke and the pain worsened. The patient had similar lesions a year ago but did not seek medical care. He has had three different female sexual partners over the past two years but has no knowledge of them having any sores or diseases.

Diagnosis: Genital herpes presents with multiple transient, painful vesicles that appear on the penis, vulva, buttocks, perineum, vagina, or cervix. The vesicles break down and become ulcers that develop crusts while healing. Recurrences typically occur 2 to 3 times a year. The duration is shorter and less painful than in primary infections. The lesions often heal completely by 8 to 10 days.

Antiviral therapy is recommended for an initial genital herpes outbreak. Although systemic antiviral drugs can partially control the signs and symptoms of herpes episodes, they do not eradicate the latent virus.

For more information on this case, see “Painful vesicles on penis.”

1. A 63-year-old man complains of a mildly painful and tender rash on his penis that has been there for almost two years. The patient is uncircumcised; when the foreskin is retracted, a bright red, erythematous, nonscaly, circumferential plaque is visible on the glans penis, spreading to the foreskin. He denies pain on urination, discharge, fever, malaise, arthralgias, and sexual contact outside of his marriage.

Diagnosis: Zoon balanitis is a benign condition that typically affects uncircumcised middle-aged to elderly men.^1,2 Worldwide prevalence among uncircumcised men is approximately 3%.² The etiology is unknown; it’s thought that this condition may be caused by friction, trauma, heat, lack of hygiene, exogenous or infectious agents, an IgE hypersensitivity, or a chronic infection with Mycobacterium smegmatis.^1,2

Typically, the appearance of the lesion precedes diagnosis by about one to 2 years.¹ The patient usually complains of mild pruritus and tenderness. Undergarments may be bloodstained.

The lesion associated with Zoon balanitis is a solitary, glistening, shiny, red-to-orange plaque of the glans penis or prepuce of an uncircumcised male. Pinpoint erythematous spots or “cayenne pepper spots” may also be associated with this condition.

For more information on this case, see “Erythematous penile lesion.” J Fam Pract. 2012;61(12):753-755.

2. A 21-year-old man presents with bumps on his penis. He admits to having unprotected sexual intercourse with more than six women in the past year. He is otherwise healthy.

Diagnosis: Genital warts are caused by human papillomavirus infection. The incubation period after exposure ranges from three weeks to eight months. Anogenital warts represent the most common viral sexually transmitted infection in the United States; there are approximately 1 million new cases of genital warts per year. Most infections are transient and clear up within two years, but some infections persist and recur.

The diagnosis is usually clinical; genital warts are typically asymptomatic and present as flesh-colored, exophytic lesions on the genitalia, including the penis, vulva, vagina, scrotum, perineum, and perianal skin. External warts can appear as small bumps, or they may be flat, verrucous, or pedunculated. Treatment options include cryotherapy and prescription imiquimod cream.

For more information on this case, see “Genital bumps.”

3. A 27-year-old man is worried that he may have contracted chlamydia. About five days ago, he experienced pain and a burning feeling with urination. Three days ago, a painful, growing lump near the head of his penis developed. The patient has a purulent urethral discharge and fluctuant, yellowish white, tender swelling on the left side of the frenulum. There are no ulcers, but there is a single 2-cm lymph node in the right inguinal area that is of normal consistency, mobile, nontender, and nonfluctuant.

Diagnosis: The clinical history was consistent with a diagnosis of gonococcal urethritis complicated by a periurethral gland abscess. The location of the swelling was most consistent with an abscess in the Tyson’s gland (also known as tysonitis). The Tyson’s (or preputial) glands of the penis are sebaceous-type glands on either side of the frenulum at the balanopreputial sulcus.¹ In women, an abscess of the periurethral Skene’s gland is an analogous gonorrheal complication.

The differential diagnosis of acute swelling on the penile shaft includes syphilis, chancroid, lymphogranuloma venereum, herpes simplex virus, Behçet’s syndrome, a drug reaction, erythema multiforme, Crohn’s disease, lichen planus, amebiasis, scabies, trauma, and cancer.

For more information on this case, see “Returning traveler with painful penile mass.” J Fam Pract. 2011 May;60(5):285-287.

4. A 32-year-old man presents with a week-long history of painful vesicles on the shaft of his penis associated with tender groin adenopathy. Two days ago, the vesicles broke and the pain worsened. The patient had similar lesions a year ago but did not seek medical care. He has had three different female sexual partners over the past two years but has no knowledge of them having any sores or diseases.

Diagnosis: Genital herpes presents with multiple transient, painful vesicles that appear on the penis, vulva, buttocks, perineum, vagina, or cervix. The vesicles break down and become ulcers that develop crusts while healing. Recurrences typically occur 2 to 3 times a year. The duration is shorter and less painful than in primary infections. The lesions often heal completely by 8 to 10 days.

Antiviral therapy is recommended for an initial genital herpes outbreak. Although systemic antiviral drugs can partially control the signs and symptoms of herpes episodes, they do not eradicate the latent virus.

For more information on this case, see “Painful vesicles on penis.”