A 20-year-old man comes to the office due to penile lesions, which began several months ago. The lesions have not enlarged, and the patient has had no fever, pain, discomfort, dysuria, or urethral discharge. He says, "These spots appeared after I had unprotected sex with a woman I met at a party. I am worried that I may have a sexually transmitted disease." The patient has not had sexual intercourse since then but masturbates regularly. He has no medical problems, takes no medications, and does not use tobacco, alcohol, or illicit drugs. The patient is a college student and works part time as a restaurant server. Vital signs are within normal limits. No lymphadenopathy or other skin rashes are present. External genitalia examination findings are shown below. Which of the following is the most appropriate next step in management of this patient's current condition?

Question

A 20-year-old man comes to the office due to penile lesions, which began several months ago.  The lesions have not enlarged, and the patient has had no fever, pain, discomfort, dysuria, or urethral discharge.  He says, "These spots appeared after I had unprotected sex with a woman I met at a party.  I am worried that I may have a sexually transmitted disease."  The patient has not had sexual intercourse since then but masturbates regularly.  He has no medical problems, takes no medications, and does not use tobacco, alcohol, or illicit drugs.  The patient is a college student and works part time as a restaurant server.  Vital signs are within normal limits.  No lymphadenopathy or other skin rashes are present.  External genitalia examination findings are shown below.  Which of the following is the most appropriate next step in management of this patient's current condition?

Quizplus · Accepted Answer

Explanation: Pearly penile papules usually arise in the second or third decade of life and are a normal variant. Manifestations typically include >1 rows of small, flesh-colored, dome-topped or filiform papules on the penile corona or sulcus. These papules are asymptomatic, harbor no malignant potential, and are not caused by a sexually transmitted infection. No intervention is generally required other than reassurance. (Choice A) A low-potency topical corticosteroid can be used to treat contact dermatitis, which usually manifests as erythema with or without vesicles, bullae, or ulcers. This patient has pearly papular lesions that are not erythematous, making contact dermatitis unlikely. (Choices B and D) A shave biopsy can be used to diagnose condylomata acuminata (anogenital warts), which are due to human papilloma virus infection. Lesions are typically skin-colored or pink and vary in appearance from smooth, flattened papules to verrucous, papilliform growths. First-line treatment with topical imiquimod, an immunomodulatory drug, can help speed clearance of the lesions. This young patient with a row of small papules on the penile sulcus is more likely to have pearly penile papules. verrucous, papilliform growths (Choice C) Oral acyclovir can be used to treat genital herpes simplex virus infection, which usually manifests with painful vesicular lesions on an erythematous base. Lesions tend to resolve spontaneously within a few weeks; persistence for months would be atypical. Educational objective: Pearly penile papules appear as >1 rows of small, flesh-colored, dome-topped or filiform papules positioned circumferentially around the corona or sulcus of the glans penis. These lesions are a normal variant and not associated with sexually transmitted infections. Because pearly penile papules are asymptomatic and harbor no malignant potential, no intervention is required other than reassurance.

A 20-Year-Old Man Comes to the Office Due to Penile