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all right I think it's time we moved on
to case number two a 23 year old man now
presents to your office concerned about
some bumps on his penis
he noticed them several weeks ago in the
shower he tried rubbing alcohol God
knows why and then a topical antifungal
to no avail these lesions are not itchy
or painful he denies any fevers or
chills no to Syria no penile discharge
his social and family history is
essentially non-contributory except that
he has been sexually active with five
female partners in the past 12 months
review of systems as negative his vital
signs are all within normal limits and
then on exam of his genital urinary
system he has numerous non tender skin
colored fleshy papules scattered on the
shaft and base of his penis
no mucosal involvement and no inguinal
lymph adenopathy so highlighting a few
key features here the time course
appears to be subacute he noticed them
several weeks ago in terms of the
pattern of skin involvement it is
asymmetric involvement exclusively of
his genitalia skin inflammation there
non-tender there don't appear to be
pustules so it doesn't sound like
there's much skin inflammation and
lastly systemic involvement we're not
seeing any so that's basically what
we've got at this point all right let's
take a look at our differential
diagnosis condyloma kuma nada AK
recordin genital herpes verruca vulgaris
and shankara's wow that's a mess of
Greek and Latin let's see if we can make
our way through it all
first off condylomata Okuma nada that's
a fancy term for genital warts the
etymology actually means pointed round
tumor which distinguishes a genital wart
from the more flat appearance of plantar
and common warts which are also called
by HPV in any event these asymptomatic
lesions are incredibly common in fact
they're the most common sexually
transmitted disease above all else and
they manifest on the shaft of the penis
they're more common and sexually active
men and women so this one clearly is
going to stay on our list
next up a crow Gordon what's with the
fancy words
okay necro Corden is the official term
for a skin tag which depicted here in
our image
it's a fleshy papilloma that most often
occurs in flexural creases like the nape
of the neck the axilla the groin we
should probably keep this one on our
list for now
general herpes
finally some English genital herpes is
typically caused by herpes simplex virus
2 though can also be caused by HSV one
it's relatively common viral infection
with myriad skin manifestations but the
lesions of HSV two are more of the
painful vesicular or ulcerative type
rather than our patients painless fleshy
papules so I think we can safely take
hsv-2 and genital herpes off the list
and here we're back to the Latin verruca
vulgaris this is a fancy word for common
wart common warts is one subtype of
cutaneous warts the others of which
include plantar warts and flat warts
we've already mentioned another type of
wart above the cutaneous wart is an
umbrella term for warts caused by HPV
that are not occurring in the anal
genital region which as we've already
discussed are called condyloma Okuma
nada see above hence since our patients
lesions are in fact in the anal genital
area if they were gonna have any kind of
work it would be condyloma Cooma nada
so we can safely take verruca vulgaris
off of our list bit of tech sodomy goes
a long way
lastly Shangri a chakra is the classic
lesion of primary syphilis it starts as
a painless papule
similar to our patient at the site of
inoculation though it eventually
progresses to a painless ulcer it'd be
unusual to have multiple lesions like we
have in our patient and also you'd more
likely have some accompanying lymph
adenopathy
now while the Shankar represents the
primary syphilis lesion the spirit
bacterium of syphilis Treponema pallidum
soon goes systemic even as the ulcer
heals over several weeks so patients
develop some systemic manifestations and
later secondary syphilis can occur
with a diffuse classic maculopapular or
rush eruption on the trunk and
extremities including the palms and
soles it's really not sounding at all
like what our patient has had for the
past several weeks so I think we can
safely take off Shangri and syphilis
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