Case Study: Postsexual Penile Ulcer as a Symptom of Diabetes
D.H., a 50-year-old married man, presented for his first office visit complaining of a “male problem,” which he described as a sore on his penis that had been present for 14 days. The patient's most recent sexual encounter was with his wife 2 weeks before the office visit. He denied any penile discharge but complained of constant pain in his “private part.” He also denied dysuria, frequency, past sexually transmitted diseases, and extramarital sexual encounters. His wife had no vaginal or perineal symptoms.
The patient reported first noticing a “blister” on the glans penis, which ruptured several days after forming. The pain intensified when the blister broke. He described the pain intensity as mild to moderate with no radiation, “sharp and stinging,” especially when washing himself and during sexual intercourse. He had not experienced nausea, fatigue, fever, or malaise.
The penile examination revealed an uncircumcised glans penis that was inflamed, erythematous, and tender. On the glans penis was a 0.5-cm, oval, erythematous-based ulceration with some crusting. There were no vesicles associated with the lesion. No penile discharge, scrotal tenderness, or scrotal abnormalities were noted.
Herpes simplex virus (HSV) and aerobic bacterial cultures of the lesion were conducted. A DNA probe for Chlamydia trachomatis and Neisseria gonorrhea were obtained. A complete blood diagnostic profile with rapid plasma reagin (RPR) for syphilis was also conducted. The patient was diagnosed with a …