Clinical Question

[BADMD]

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So I saw a 21 year old AA male with a painless penile lesion. He noticed it the night before. No symptoms of any kind. Only medical history is previously treated GC. No trauma

The lesion is about 1 x 1 cm, red, flat, with a small abrasion in the center. He said it was bleeding early that day. No penile discharge. No testicular tenderness. No palpable nodes.

Any thoughts?

Oh yeah, and his RPR is negative.

 

[mountainman123]

Haemophilus Ducreyi is the only painless penile lesion that I can think of.

 

[Apollyon]

Haemophilus Ducreyi is the only painless penile lesion that I can think of.

H. ducreyi has the painful soft chancre (a/k/a "chancroid"). T. pallidum is the painless hard chancre.

 

[deleted109597]

Yep. Treponeme.

 

[NinerNiner999]

Primary syphillis - the painless chancre. RPR may remain negative until high titers are present (and this is a new lesion). Sample the lesion, send it for dark-field microscopy, and repeat RPR/FTA-ABS in two days. 2.4 Million units of Benzathene Pencillin G IM should to do the trick...

 

[deleted109597]

Also, tell the patient to double bag it from now on.

 

[BADMD]

Primary syphillis - the painless chancre. RPR may remain negative until high titers are present (and this is a new lesion). Sample the lesion, send it for dark-field microscopy, and repeat RPR/FTA-ABS in two days. 2.4 Million units of Benzathene Pencillin G IM should to do the trick...

I actually called one of the ID attendings today about this guy. It turns out that with a slightly off question, they are willing to put their clinic on hold and discuss a case.

Anyway, he said much as you did, however he did say that in a certain percentage of case, chancroid is painless as well. He recommended an alternate test on the blood sample, which, thankfully, the lab can do as they didn't toss his blood sample yet.

Fortunately, I gave him ceftriaxone and penicillin, so both diagnoses are covered. Hopefully he doesn't really have penile cancer, which is the third likely possibility that ID could come up with.