Active primary penile ulcer

Active primary penile ulcer in a 30-year-old cisgender man with HMPX, imaged at lesion day 18.

Located on the foreskin at the penile base is a 15 x 10 mm irregularly-shaped tender ulcer with an erythematous base and no surrounding erythema. This ulcer, part of the primary crop of lesions, predated the systemic symptoms, and was associated with tender bilateral inguinal lymphadenopathy and a faint nonpruritic, nontender maculopapular suprapubic rash.  This lesion took 27 days to heal.

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.