Penile discharge as a presentation of perirectal abscess

Anorectal abscesses are a common presentation to the Emergency Department, but are frequently misdiagnosed. We report a patient in whom penile discharge was the presenting symptom of an ischiorectal abscess. A 42-year-old man presented with scrotal pain, swelling, and penile discharge. The genitourinary examination revealed a tender scrotum, and a fluctuant mass was identified on digital rectal examination. Computed tomography (CT) scan revealed an ischiorectal abscess with extension into the corpus cavernosum. We believe our patient's penile discharge was a manifestation of this abscess extension. Penile discharge is typically suggestive of sexually transmitted infections. Although rare, perirectal abscess should be considered in the differential diagnosis of penile discharge. A thorough digital rectal examination should be performed seeking the presence of mass or fluctuance.