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ULY CLINIC

10 Septemba 2025, 11:50:03

Genital Lesions in the Male

Male genital lesions can take many forms, including warts, papules, ulcers, scales, and pustules. They may be painful or painless, singular or multiple, and may be confined to the genitalia or occur elsewhere on the body. Lesions may result from infection, neoplasms, parasites, allergies, or drug reactions. These conditions can profoundly affect a patient’s self-image and relationships, sometimes causing hesitation in seeking medical care due to fear of cancer or sexually transmitted diseases (STDs). Notably, genital ulcers increase the risk of HIV transmission between sexual partners.

History and Physical Examination

History: Begin by asking when the lesion first appeared, any recent drug intake, travel history, or prior similar lesions and their treatment. Determine whether the patient has attempted self-treatment and whether the lesions are itchy or painful. Assess any drainage from lesions and take a complete sexual history, including frequency of sexual activity, number of partners, and condom use.

Examination: Observe clothing before examination; tight or nonabsorbent fabrics can promote bacterial and fungal growth. Examine the entire skin surface, noting lesion location, size, color, pattern, and similarity to other body lesions. Palpate for nodules, masses, tenderness, bleeding, edema, or signs of infection such as purulent discharge or erythema. Take vital signs as part of the assessment.

Medical causes

Condition	Key Features	Clinical Notes
Balanitis/Balanoposthitis	Painful ulceration of glans and prepuce, foul discharge, edema	May progress to gangrene and life-threatening sepsis if untreated; often preceded by prepuce irritation
Bowen’s Disease	Painless, raised, scaly, indurated plaque with well-defined borders, may ulcerate	Premalignant lesion, typically on penis or scrotum
Chancroid	Painful, deep ulcer <2 cm, gray/yellow exudate, tender inguinal lymphadenopathy	Rapid progression from papule to pustule to ulcer
Genital Herpes	Fluid-filled vesicles on glans, foreskin, or shaft; recurrent episodes cause tingling	Vesicles rupture into shallow, painful ulcers with erythema and tender lymph nodes
Genital Warts	Flesh-colored papillary growths, cauliflower appearance, may be malodorous	Often start on subpreputial sac or urethral meatus; painless initially
Tinea Cruris (Jock Itch)	Itchy, well-defined, scaly patches on inner thighs and groin	May extend to scrotum and penis
Folliculitis/Furunculosis	Red, tender, central pustules or hard nodules; rupture releases pus	Painful; may persist with erythema and edema
Leukoplakia	White, scaly patches with skin thickening and occasional fissures	Precancerous; usually glans or prepuce
Pediculosis Pubis	Erythematous, pruritic papules, visible lice or eggs	Usually perianal, pubic, thigh, and abdominal regions
Penile Cancer	Painless, enlarging wartlike lesion; foul-smelling discharge	May obstruct urination; often associated with firm glans lumps and enlarged lymph nodes
Scabies	Crusted, threadlike lesions with nocturnal itching	Common on penis, scrotum, wrists, elbows, axillae, waist
Syphilis (Primary)	Painless, firm, indurated ulcer (chancre) with scant yellow serous discharge	May have unilateral regional lymphadenopathy
Urticaria	Raised, intensely pruritic wheals with erythematous flare	Allergic reaction, may affect foreskin or shaft

Special Considerations

Many penile lesions resemble syphilis; screen all patients with penile lesions for STDs using dark-field examination and VDRL testing. Prepare patients for biopsy when penile cancer is suspected. Provide emotional support, especially when cancer is a concern. Maintain strict infection control: wash hands before and after patient contact, wear gloves, and properly dispose of contaminated materials.

Patient Counseling

Explain the use of topical treatments, methods to relieve crusting and itching, and signs that should prompt medical attention. Emphasize proper condom use.

Pediatric Pointers

Infants: Contact dermatitis may cause minor irritation or bright red, weepy lesions. Disposable diapers and proper hygiene reduce diaper rash.
Children: Impetigo may cause pustules with thick, yellow crusts. Genital warts may require excision with reassurance. Evaluate children with STDs for possible sexual abuse.
Adolescents (15–19 years): High incidence of STDs; syphilis can cause congenital infection if transmitted in utero.

Geriatric Pointers

Sexually active older adults with multiple partners remain at risk for STDs. Reduced immunity, poor hygiene, underreporting of symptoms, and concurrent conditions may alter presentation. Seborrheic dermatitis may be more severe in bedridden patients or those with Parkinson’s disease.

References

Batista, C. S., Attallah, A. N., Saconato, H., & da Silva, E. M. (2009). 5-FU for genital warts in non-immunocompromised individuals. Cochrane Database Systematic Review, 4, CD006562.
Garland, S. M., Steben, M., Sings, H. L., James, M., Lu, S., Railkar, R., … Joura, E. A. (2009). Natural history of genital warts: Analysis of the placebo arm of 2 randomized Phase III trials of a quadrivalent HPV vaccine. Journal of Infectious Disease, 199(6), 805–814.