Painless Penile Lesion in a 52-Year-Old Man

By Anthony
This is another one of those interesting Guess my diagnosis game. If you're up to it, check this out...

Background

A 52-year-old man with no clinically significant medical history presents to the emergency department (ED) with a chief complaint of a “rash” on his penis. The patient states that the rash first appeared 1 week before presentation. He denies any dysuria, urethral discharge, pruritus or pain in the area of the lesion. This is the first time he has had such a rash. He admits to having had several recent sexual partners.

On physical examination, his vital signs are normal. The patient has a well-demarcated, ulcerated lesion on the ventral aspect of his penis (see Image). The lesion is not tender to palpation. No other lesions are noted, and no discharge is observed from the urethra. The findings of his testicular examination are unremarkable, with the exception of bilateral prominent inguinal lymphadenopathy. The remaining physical findings, including the cardiac and abdominal findings, are unremarkable.

What do you think is the diagnosis, and what empiric treatment is necessary?

Hint

The lesion is characteristically painless.

Image



See Answer