Persistent Genital Ulceration

REPORT OF A CASE A 29-year-old man presented to a local physician for evaluation of a penile ulcer that had been present for 2 weeks. The patient was treated with tetracycline for 2 weeks followed by doxycycline calcium for 2 weeks without improvement. A surgical excision was performed, and there was dehiscence of the wound with a resultant persistent painful ulceration. He was referred to our dermatology clinic for further evaluation and treatment. The patient denied a history of sexually transmitted diseases, specifically, genital ulcers. He also denied fevers, chills, or malaise associated with the present problem. Physical examination showed a solitary indurated 2.4-cm tender lesion on the glans penis with a purulent ulcerated base (Fig 1). He had bilateral inguinal adenopathy. The remainder of the mucocutaneous examination was within normal limits. A smear was taken from the undermined border of the ulcer and stained with Wright's, Giemsa, and Gram's