Jesse Rokicki Parashar, MD Andrew Schechtman, MD San Jose-O’Connor Hospital Family Medicine Residency, Calif aschecht@stanford.edu
DEPARTMENT EDITOR Richard P. Usatine, MD University of Texas Health Science Center at San Antonio
The authors reported no potential conflict of interest relevant to this article.
Our patient thought he’d practiced “safe sex” while traveling in Vietnam. But a week after his return, he sought care for a tender penile lump and painful urination.
WORRIED THAT HE MIGHT HAVE CONTRACTED CHLAMYDIA, a 27-year-old man visited our clinic for treatment. About 5 days earlier, he’d begun experiencing pain and a burning feeling when he urinated. Three days earlier, a painful lump near the head of his penis developed; the lump was growing.
The patient, who was otherwise healthy, had recently returned from a trip to Vietnam during which he reported having had sex with one female partner. He said, “I thought I was safe. I used a condom.”
On examination, he had a purulent urethral discharge and there was a fluctuant, yellowish-white, tender swelling on the left side of the frenulum (FIGURE). There were no ulcers. There was, however, a single 2-cm lymph node in the right inguinal area that was mobile, nontender, nonfluctuant, and of normal consistency.
FIGURE Swelling with purulent discharge
In addition to the fluctuant, yellowish white, tender swelling on the left side of the frenulum, the patient had purulent urethral discharge and a single, 2-cm lymph node in the right inguinal area.
WHAT IS YOUR DIAGNOSIS? HOW WOULD YOU TREAT THIS PATIENT?
