Active secondary penile ulcers in a 30-year-old cisgender man with HMPX.
Located at the base of the penile shaft are two round 15-mm tender ulcers with developing granulation tissue, clear serous drainage, and slightly rolled borders surrounded by resolving poorly demarcated erythema, imaged at lesion day 9. These lesions took 18 days to heal.
A third smaller ulcer overlies the foreskin of the distal penis that is 10 mm in diameter, imaged at lesion day 12.
These ulcers are associated with tender bilateral inguinal lymphadenopathy. 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.