Active primary genital ulcers in a 30-year-old cisgender man with HMPX, imaged at lesion day 12.
Located on the corona of the glans penis is a tender 10-mm shallow-based ulcer with regular, raised borders and surrounding erythema. A similar ulcer is visible on the inner side of edematous, retracted foreskin. There are also numerous tiny erythematous papules and pustules across the glans. The ulcers were part of the primary crop of lesions and predated the systemic symptoms and took 27 days to heal.
Tender bilateral inguinal lymphadenopathy followed 2 days after the initial crop of lesions. This was mistaken for syphilis, for which he received treatment empirically, prior to receiving the diagnosis of HMPX.
There was no history of immunocompromising conditions or medications. This man was on Truvada for HIV pre-exposure prophylaxis. He also received Imvamune for HMPX pre-exposure prophylaxis 3 days before illness onset