A 38-year-old man was referred to our clinic with a 2-week history of painful lesions located on the penis. He had no past medical history for this event. During the first few days of onset, he had a fever (38.5ºC) without any other systemic symptoms. Treatment with ketoconazole cream and topical steroids had worsened the lesions. A physical examination revealed a number of small ulcers with a fibrin surface and a herpetiform distribution in the coronal sulcus and glans penis. Bilateral inguinal palpation revealed the presence of small and mobile lymph nodes. Tzanck test results showed multinucleated giant cells and epithelial cells containing eosinophilic intranuclear inclusion bodies. Laboratory workup included a hemogram and biochemistry and coagulation tests, which all had negative or normal results.
The most likely diagnosis is
Primary syphilis
Chancroid
Reiter syndrome
Genital herpes
Behçet syndrome
Answer on page 1304