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5mm slow healing ulcer on shaft of penis
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5mm slow healing ulcer on shaft of penis

I am a 36 year old, sexually active, white male. About 3 weeks ago, I notice a solitary red bump (papule) on the shaft of my penis. At the time I thought it was an infected follicle or irritation. I had had similar bumps before which would resolve quickly. However, about 4 days later, the bump formed a head and became an open sore (ulcer) with a moist center, but it did not seem to ooze much even if disturbed by rubbing.  It would then form a thick scab. I assumed it was a boil. The 5mm sq lesion is round, slightly raised on a pink base with the round ulcer in the center. In its current state, it blanches when pressed. The ulcer always forms a thin translucent scab when dry. It is smooth and shiny and occasional there is some skin peeling. At the time it first ulcerated, it was probably bigger than 5 mm sq and more irritated. However, it was/is not painful or itchy. In the shower, the crater will turn white when it gets wet. Since it did not resolve, I went to my primary care clinic at a Boston teaching hospital on day 9 assuming I might have a chancre of primary syphilis (although my sore did not look like any of the pictures I had seen - it was far less extensive). I was swabed for HSV (negative) and treated presumptively for prinmary syphilis with doxycyxline for 14 days. The RPR was negative, but it would not be reactive so soon anyway. After 7 days on doxy, day 16, I began to worry because the sore was not resolving although it looked slightly better. Its size had not changed and the crater in its center was not closing, although was shrinking slightly. My anxiety increased so on day 19 I went to see a dermatologist at the same teaching hospital for peace of mind. A derm resident and professor both looked at the sore - which by now I worried whether it was some sort of squamous cell carinoma in situ or some other cancer. Both dermatologists agreed that while it was not a typical chancre, they both seemed to favor that diagnosis as a definite possibility. I enquired about cancer and they both agreed strongly that it did not look like any cancer or pre-cancerous leasion. Its fast evolution led them to believe it was an infectious process. I also had some palpable inguinal lymph nodes which further affirmed for them an infection. The plan is that I put Bactroban ointment on it for 14 more days while awaiting the additional syphilis tests (another RPR and an FTA-ABS). If they tests are negative and the sore remains unhealed, the plan is to do a shave biopsy (day 34). I guess after all this, I am looking for a 2nd opinion via this forum. I think I have done all the necessary steps, but I am deeply worried that something is wrong and that it is not syphilis, but something rare and potentially mutilating if not deadly. The derm folks were aware of my fear, but reassured me based oh their clincal experience. Can you provide any insight or opinion based on your experience with solitary lesions on the penile shaft?

Many thanks.
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I think the doctors are proceeding correctly, and that their counseling and proposed course of action are exactly right.  A biopsy may indeed be needed.  I certainly understand your anxiety and I suppose this will not be completely allayed until definitive diagnosis is reached.  Nevertheless, it is, as your doctors say based on their clinical experience, most unlikely that you have anything serious or mutilating.  Hang in there...

Best.

Dr. Rockoff
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