Active primary penile ulcer in a 30-year-old cisgender man with HMPX, imaged at lesion day 18.
Located on the corona of the glans penis is a tender 10-mm shallow-based ulcer with receding borders. The ulcers were part of the primary crop of lesions and took 27 days to heal.
A lesion previously located on the inner side of the retracted foreskin is now healed with no visible scar. Similarly, numerous papules across the glans have healed with no visible scar.
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.