Returning traveler with painful penile mass

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Returning traveler with painful penile mass

J Fam Pract. 2011 May;60(5):285-287

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References

1. Batistatou A, Panelos J, Zioga A, et al. Ectomic modified sebaceous glands in human penis. Int J Surg Pathol. 2006;14:355-356.

2. Burgess JA. Gonococcal tysonitis without urethritis after prophylactic post-coital urination. Br J Vener Dis. 1971;47:40-41.

3. Bavidge KJ. Letter: gonococcal infection of the penis. Br J Vener Dis. 1976;52:66.-

4. Abdul Gaffoor PM. Gonococcal tysonitis. Postgrad Med J. 1986;62:869-870.

5. Frenkl T, Potts J. Sexually transmitted diseases. In: Wein AJ, Kavoussi LR, Novick AC, et al, eds. Campbell-Walsh Urology. 9th ed. Philadelphia, Pa: Saunders; 2007:371–385.

6. Nelson AL. Gonorrheal infections. In: Nelson AL, Woodward JA, eds. Sexually Transmitted Diseases: A Practical Guide for Primary Care. Totowa, NJ: Humana Press; 2007:153–182.

7. Centers for Disease Control and Prevention. Sexually transmitted disease surveillance 2009. Available at: www.cdc.gov/std/stats09/surv2009-Complete.pdf. Accessed March 25, 2011.

8. Marrazzo JM, Handsfield HH, Sparling PF. Neisseria gonorrhoeae. In: Mandell GL, Bennett JE, Dolin R, eds. Mandell, Douglas, and Bennett’s Principles and Practice of Infectious Diseases. 7th ed. Philadelphia, Pa: Churchill Livingstone 2009;2753-2770.

9. Adler MW. ABC of sexually transmitted diseases: complications of common genital infections and infections in other sites. Br Med J. 1983;287:1709-1712.

10. Subramanian S. Gonococcal urethritis with bilateral tysonitis and periurethral abscess. Sex Transm Dis. 1981;8:77-78.

11. Komolafe AJ, Cornford PA, Fordham MV, et al. Periurethral abscess complicating male gonococcal urethritis treated by surgical incision and drainage. Int J STD AIDS. 2002;13:857-858.

12. Furuya R, Takahashi S, Furuya S, et al. Is urethritis accompanied by seminal vesiculitis? Int J Urol. 2009;16:628-631.

13. Rosen T, Hwong H. Sclerosing lymphangitis of the penis. J Am Acad Dermatol. 2003;49:916-918.

14. Centers for Disease Control and Prevention. Sexually transmitted diseases treatment guidelines 2006. Diseases characterized by urethritis and cervicitis. Available at: http://www.cdc.gov/STD/treatment/2006/urethritis-and-cervicitis.htm#uc6. Accessed January 26, 2010.

15. el-Benhawi MO, el-Tonsy MH. Gonococcal urethritis with bilateral tysonitis. Cutis. 1988;41:425-426.

16. Centers for Disease Control and Prevention. Increases in fluoroquinolone-resistant Neisseria gonorrhoeae—Hawaii and California, 2001. MMWR Morb Mortal Wkly Rep. 2002;51:1041-1044.

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Diagnosis: Tysonitis

The clinical history was consistent with a diagnosis of gonococcal urethritis complicated by a periurethral gland abscess. The location of the swelling was most consistent with an abscess in the Tyson’s gland (also known as tysonitis). The Tyson’s (or preputial) glands of the penis are sebaceous-type glands on either side of the frenulum at the balanopreputial sulcus.¹ In women, an abscess of the periurethral Skene’s gland is an analogous gonorrheal complication.

FAST TRACK

Nucleic acid amplification testing has the advantage of being approved for use with urine specimens from men and women, as well as with endocervical or urethral samples.

Case reports of gonorrheal infection of Tyson’s gland have documented infection with and without symptoms of urethritis.^2-4 Diagnosis in this case was confirmed by sending the discharge for nucleic acid amplification testing (NAAT), which was positive for Neisseria gonorrhoeae and negative for Chlamydia trachomatis.

Other diagnostic possibilities. The differential diagnosis of acute swelling on the penile shaft includes syphilis, chancroid, lymphogranuloma venereum, herpes simplex virus, Behçet’s syndrome, a drug reaction, erythema multiforme, Crohn’s disease, lichen planus, amebiasis, scabies, trauma, and cancer.⁵

How this patient’s attempt at “safe sex” failed
Oropharyngeal gonococcal infection was the route of transmission implicated in this patient’s infection. When specifically asked about his sexual encounter, our patient admitted that while he was diligent about using a condom for intercourse, he did not use a condom when he received oral sex.

The prevalence of pharyngeal involvement is estimated to be 10% to 20% among women and MSM (men who have sex with men) who have genital gonorrheal infection.⁶ The risk of contracting N gonorrhoeae when receiving oral sex from an infected partner is unknown.

A common disease, a not-so-common complication
Genital infection by N gonorrhoeae remains the second most common notifiable disease in the United States, with 301,174 cases reported in 2009.⁷ Effective antimicrobial treatment has reduced the occurrence of local complications of gonococcal infection. Nevertheless, complications of gonococcal urethritis like the ones that follow do occur.