Anxiously waiting a follow up appointment

[Mist13]

Thanks for your input. I have a penile ulcer that has been seen be my PCP and all STD blood tests were negative. Regardless, my PCP decided to treat it and not wait for results. I have talked on the StD forum and they seemed assured that my end result was indeed not STD related. But my PCP told me to follow up with urology and the experts on the STD forum said I should ask a dermatologist. So I posted a pick of my sore on my profile, and this pick is 4 days after PCN treatment. Now it is 6 days after and It does not seem to have responded to the IM penicillin dose.

So my question is... What is it? It occurred, or just showed up in the end of Feb. and I was under a TON of stress at that time. But I have never heard if getting a stress ulcer where I have one!

Any input is welcome. And should I keep my appointment with urology, even though it is not until April 9? Or should I try to see a dermatologist sooner?

Thanks again,
MA

[Bhupinder Kaur, MD]

Hello,
Thanks for posting your query.
I can understand your concern for the single painless ulcer on the penis. You have not mentioned anything regarding your sexual history and the STD blood tests that you have got done but for such a painless ulcerative solitary lesion on the penis, syphilis and lymphogranuloma venereum are two possibilities which should be ruled out if you are sexually active.

People with primary syphilis will develop one or more sores. The sores resemble large round bug bites and are often hard and painless. Although single dose of penicillin is sufficient to treat the sore but some resistant cases may need repeated doses. You have mentioned that many blood tests for STD’s have been done but confirmation is required with a treponemal test, such as treponemal pallidum particle agglutination (TPHA) or fluorescent treponemal antibody absorption test (FTA-Abs). If these have not been done, then you should get them done.

Lymphogranuloma venereum also presents as painless genital ulcer that occurs at the contact site. To confirm the diagnosis, real time PCR can be done. Please check your lab investigations and if these tests have not been done before then you can discuss about these tests with your dermatologist and get them done.

Other than that since there was no response to the antibiotic, you should get the ulcer cultured for fungal infection and viral infection (due to herpes although less likely)also. It is less likely to be related to stress and it is important to rule out infection as the source of this ulcer.

Hope that this information helps and hope that you get better soon.

Wishing you good health.

[Mist13]

Never mind with the photo, it would not load. But it is a single raised, red, painless, with thicker borders and ulcerated center.
I will try again later.