A 36-year-old male native of Guyana, South America, presented with a rapidly expanding penile lesion. Although painless, the lesion bled easily with even minor friction. The otherwise healthy patient was in America to visit family.
Key point: This friable lesion with rapid and destructive growth is classic for granuloma inguinale. This disease is rarely seen in the United States, but remains endemic in parts of India, Brazil, South America, the Caribbean, New Guinea, and the interior of Australia. The diagnosis was confirmed by biopsy, which revealed a plethora of parasitized histiocytes; organisms stained with tissue silver stain. Without treatment, the infection can literally obliterate the genitalia.
Treatment: Trimethoprim/sulfamethoxazole (double-strength) was administered by mouth, twice daily, until the entire lesion healed (approximately 5 weeks).
Note: Relapse requiring re-treatment can occur up to 18 months after ostensibly successful therapy.