Traumatic purpuric penile ulcer

A 33-year-old man presented with a history of a penile ulcer of four days' duration. He was immediately treated with 2.4 million IU of benzathine penicillin IM and tested for syphilis, but subsequently proved non-reactive. He was already receiving doxycycline BID from another physician for this nonspecific genital ulcer and minocycline for acne. Past medical history revealed periodic flares of hidradenitis suppurativa, limited to the buttocks and inguinal region; acne, involving the face and back; and angiokeratoma of the scrotum. He had no known drug allergies, nor had he admitted to taking any other medicaments. Examination revealed an 8 x 15 mm irregularly shaped, shallow, tender ulcer over a larger purpuric base and involving part of the corona and the distal portion of the shaft. No inguinal adenopathy or buboes could be found on palpation. The patient was placed on a cream containing 3% iodochlorhydroxyquin 1% hydrocortisone. By the end of two weeks of therapy, the lesion had healed with no residual discoloration. Subsequently, the patient revealed that he masturbated daily, rubbing his penis back and forth on the bed sheet while lying prone on the bed. Eleven months later, he consulted us again for a new purpuric penile ulcer, because he had begun to masturbate in his usual fashion. The ulcer healed within several days, and there were no sequellae.