Dr. Thakare Sampada Avinash
Dermatology
The following is an actual conversation between an iCliniq user and a doctor that has been reviewed and published as a Premium Q&A.
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Patient's Query
Hello doctor,
I am a sexually active gay male. I always use condoms for anal sex. I have a spot on the shaft of the penis, which is a little tender to touch. It is raised and smooth with nothing inside. It has been like this for just under a week. Could it be syphilis? I have some acne on my inner thigh. I sometimes have bigger spots around that area that take time to heal but never usually on the penis.
Hello,
Welcome to icliniq.com.
In syphilis, there is ulceration. An ulcer is painless, round, well-circumscribed and indurated. It is associated with lymph node enlargement. With known history and recurrent episodes, you should get your STD (sexually transmitted diseases) profile done. This could be chancroid or atypical herpes genitalis since you had a history of similar lesions in the groin area. The other differential would be non-STI like Bowen's disease in which a skin biopsy would be needed.
Patient's Query
Hello doctor,
Thank you for your reply.
To be clear, I have not had similar lesions. The other spots I have had have been recognized as acne by my doctor and have not been similar to this. Can you explain what you mean by 'circumscribed indurated'? When you look at the photos, do you think it resembles a syphilis ulcer? I am not sure I understand the difference between a spot and an ulcer. I will get an STD profile completed when I can, but at what point do you think I should be concerned about this lesion? After one more week, if it has not gone, for example?
Hello,
Welcome back to icliniq.com.
Yes, you may get acneiform eruptions in the groin area. Topical application of Fusidic acid 2 % cream helps. Indurated means firm or hard on palpation and circumscribed means a well-defined lesion which is localized. An ulcer is basically the erosion of the skin with varying features.
In herpes, there are multiple small clean looking ulcers without any slough. Chancroid ulcer is associated with yellow-grey slough which is painful. It can be a single ulcer with 0.4" to 0.8" size. Syphilitic ulcers are painless. Looking at the image (attachment removed to protect patient identity) does not look like chancre. But, before directly going on to a diagnosis, a clinical examination should be done, which is very important in this case. As I said, non-STI differential needs to be ruled out. Please consider visiting a dermatologist.
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