Derma Case: 23-year-old Man with Bumps on His Penis

by Stephen Holt, MD, MS

My Notes
  • Required.
Save Cancel
    Learning Material 2
    • PDF
      Slides Virally-mediated Skin Lesions.pdf
    • PDF
      Download Lecture Overview
    Report mistake

    00:01 Alright, I think it's time we moved on to case number 2.

    00:05 A 23-year-old man now presents to your office, concerned about some bumps on his penis.

    00:11 He noticed them several weeks ago in the shower.

    00:13 He tried rubbing alcohol, God knows why, and then a topical antifungal, to no avail.

    00:19 These lesions are not itchy or painful, he denies any fevers or chills, no dysuria, no penile discharge.

    00:26 His social and family history is essentially non-contributory, except that he has been sexually active with 5 female partners in the past 12 months.

    00:35 Review of systems is negative, his vital signs are over the normal limits.

    00:39 And then on exam of his genitourinary system, he has numerous, nontender, skin colored, fleshy papules, scattered on the shaft and base of his penis.

    00:49 No mucosal involvement and no inguinal lymphadenopathy.

    00:53 So, highlighting a few key features here, the time course appears to be subacute.

    00:58 He noticed them several weeks ago.

    01:00 In terms of the pattern of skin involvement, it is asymmetric involvement exclusively of his genitalia.

    01:06 Skin inflammation, they're nontender, there don't appear to be pustules so doesn't sound there's much skin inflammation.

    01:13 And lastly, systemic involvement - we're not seeing any.

    01:16 So, that's basically what we've got at this point.

    01:20 Alright, let's take a look at our differential diagnosis.

    01:23 Condyloma acuminata, acrochordon, genital herpes, verruca vulgaris and chancres.

    01:30 Well that's a mess of Greek and Latin.

    01:32 Let's see if we can make our way through it all.

    01:34 First off, condylomata acuminata, that's a fancy term for genital warts.

    01:40 The etymology actually means pointed, round tumor which distinguishes a genital wart from the more flat appearance of plantar and common warts which are also caused by HPV.

    01:52 In any event, these asymptomatic lesions are incredibly common.

    01:56 In fact, they're the most common sexually transmitted disease above all else and they manifest on the shaft of the penis.

    02:02 They're more common in sexually active men and women so this one clearly is gonna stay on our list.

    02:10 Next stop, acrochordon.

    02:12 What's with the fancy words? Okay, an acrochordon is the official term for a skin tag which is depicted here in our image.

    02:20 It's a fleshy papilloma that most often occurs in flexural creases, like the nape of the neck, the axilla, the groin.

    02:26 We should probably keep this one on our list for now.

    02:30 Genital herpes, finally some english.

    02:33 Genital herpes is typically caused by herpes simplex virus 2, though it can also be caused by HSV 1.

    02:40 It's relatively common viral infection with myriad skin manifestations but the lesions of HSV 2 are more of the painful vesicular or ulcerative type rather than our patient's painless, fleshy papules.

    02:54 So I think we can safely take HSV-2 and genital herpes off the list.

    03:01 And here we're back to the latin.

    03:02 Verruca vulgaris This is a fancy word for common wart.

    03:07 Common warts is one subtype of cutaneous warts.

    03:11 The others of which include plantar warts and flat warts, we've already mentioned another type of wart above.

    03:16 Cutaneous wart is an umbrella term for warts caused by HPV that are not occuring in the anogenital region which is we've already discussed are called condylomata acuminata.

    03:27 see above.

    03:28 Hence, since our patient's lesions are in fact in the anogenital area, if they were gonna have any kind of wart, it would be condylomata acuminata.

    03:37 So we can safely take verruca vulgaris off of our list.

    03:41 A bit of taxonomy goes a long way.

    03:44 Lastly, chancre.

    03:46 A chancre is the classic lesion of primary syphilis.

    03:50 Now it starts as a painless papule, similar to our patient at the site of inoculation.

    03:56 though it eventually progresses to a painless ulcer.

    04:00 It'd be unusual to have multiple lesions like we have on our patient and also, you'd more likely have some accompanying lymphadenopathy.

    04:07 Now, while the chancre represents the primary syphilis lesion, the spirochete bacterium of syphilis, Treponema palliidum, soon goes systemic even as the ulcer heals over several weeks.

    04:18 So, patients develop some systemic manifestations.

    04:21 And later, secondary syphilis can occur with a diffuse, classic, maculopapular rash eruption on the trunk and extremities, including the palms and soles.

    04:30 It's really not sounding at all like what our patient has had for the past several weeks, so I think we can safely take off chancre and syphilis.

    About the Lecture

    The lecture Derma Case: 23-year-old Man with Bumps on His Penis by Stephen Holt, MD, MS is from the course Skin Infections.

    Included Quiz Questions

    1. Herpes simplex virus 2
    2. Herpes simplex virus 1
    3. Human papillomavirus
    4. Herpes simplex virus 3
    5. Herpes simplex virus 4
    1. It commonly presents as asymptomatic skin lesions over the genitalia in sexually active patients.
    2. It is the third most common sexually-transmitted disease.
    3. It commonly affects palms and soles.
    4. It is caused by cytomegalovirus.
    5. Inguinal lymph nodes are usually enlarged and tender.

    Author of lecture Derma Case: 23-year-old Man with Bumps on His Penis

     Stephen Holt, MD, MS

    Stephen Holt, MD, MS

    Customer reviews

    5,0 of 5 stars
    5 Stars
    4 Stars
    3 Stars
    2 Stars
    1  Star