Genital injuries and ulcers

Blood tests done for syphilis may still be negative when primary syphilis lesions are already present; the luetic ulcer may in fact be visible 9-10 days after exposure to the infectious agent while blood tests become positive 3-4 weeks after infection.
If the ulceration is due to Reiter's syndrome balanitis (circinata), scabies or Bechet's syndrome, similar lesions may be found in the extragenital area.
The three tropical pathological conditions (carcinoid, inguinal granuloma and venereal lymphogranuloma) are suspected based on the patient's history of recent travel and the appearance of the lesions; they require special culture media to identify the responsible organisms.
Finally, the possibility of an ulcerated carcinoma, suspected on the basis of the characteristics of the lesion, should not be overlooked.

Non-tumor productive lesions

Acuminate warts

it is a frequently encountered pathology and, at times, difficult to resolve. The transmission of the causative agent, a Papillomavirus belonging to the group of Papova, it almost always occurs through sexual intercourse. Infection from the hands to the genitals is less frequent. The infectivity of sexually transmitted warts is 60%; the incubation period is highly variable (from 2 weeks to 8 months, on average 3 months). Warts grow in warm and humid skin areas; in males they can be observed on the glans and on the shaft, on the foreskin, on the frenulum, in the urethra, on the scrotum, in the anal region and in the rectum. Upon physical examination, they consist of a villous proliferation, often secreting, which protrudes above the skin and which sometimes ulcerates. Diagnosis based on the appearance of the lesion is usually not difficult, but acute warts must be differentiated from molluscum contagiosum and flat warts of secondary syphilis, which appear as flat, non-secreting nodules.

Contagious mollusk

It is a viral disease transmitted both by sexual contact and through personal items (clothing, towels). It is caused by a Poxvirus and has an incubation period ranging from 2 to 12 weeks. The lesions of the molluscum contagiosum consist of papules resembling a navel (umbilicated) and of the color of pearls, of 2-5 millimeters in diameter, which appear in the genital area. If the contact has not occurred sexually, however, they can be present and visible everywhere. The diagnosis is based only on the appearance of the papules because the virus cannot be grown in the laboratory).

Scleroatrophic lichen

it is a rare disease, of unknown cause, which affects individuals between 30 and 60 years of age. The skin of the affected area is atrophic (retracted and shrunken) and with white plaques. When it affects the male genitals we speak of balanitis xerotica obliterans. In men, the most affected sites are the glans, the urethra and the foreskin. they can find white plaques on the glans and on the foreskin, the urethra can also be surrounded by a small ring of white tissue, which goes up for a short distance inside, so that the first centimeter is hard and rigid and it becomes difficult to urinate. Similar skin changes can also be observed in other parts of the body. Diagnosis is clinical and under the microscope; it is possible, even if rare, a tumor degeneration of the lesions.

Lichen planus

It is a dermatitis caused by a "dysregulation" of the immune system and usually presents with itchy, lilac-colored papules or plaques on the glans, penis, foreskin and scrotum. The lesions, which resemble those of secondary syphilis, may also have a non-genital location.

Psoriasis

At the genital level, there may also be a "scales" type lesion due to psoriasis, associated or not with that of other parts of the body. However, if the localization occurs in constantly humid areas, the lesions can lose their "scaly" character and take on an "erythema" type appearance, which must be differentiated from fungal lesions caused by tinea cruris, candid, and by others such as the lichen planus and the secondary syphilis.

Dermatitis

The most common types of genital dermatitis are seborrheic and contact dermatitis. The first is rare at the genital level (more common on the scalp, ear, armpits); the second is often related to the predisposition of the patient himself or to the use of particular soaps, clothing, drugs. Diagnostic confirmation is given by the positivity of allergic tests on the skin.

Dermatitis artefacta

Those injuries are included which do not present analogy with any known pathology, and which the patient inflicts on himself. They have the characteristic of always being located in easily accessible areas for the patient.

Lymphocele

It is a "benign disease that greatly alarms the patient, who notices a swelling like a cord on the foreskin, sometimes associated with inflammation of the lymphatic vessels of the back of the penis. It can result from prolonged or particularly energetic sexual intercourse or masturbation. This pathology. occurs for a temporary obstruction of the lymphatic vessels of the penis and does not require any therapy.