Infectious Penile Lesions
Last month, you conquered the diagnosis of noninfectious penile lesions—but do you know what to look for in their infectious counterparts? The physical resemblance between these lesions can make for a baffling diagnosis.
Match the diagnosis to the photo by letter
a. Gonococcol tysonitis
b. Zoon balanitis
c. Genital herpes
d. Human papillomavirus
For answers, see next issue; for discussion, go to www.mdedge.com/clinicianreviews/picture
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.
