TRICHOMONAL ABSCESS OF THE MEDIAN RAPHE OF THE PENIS

A 32‐year‐old man presented with a painful swelling on the skin of the penis of 3 weeks' duration. He had frequent unprotected, sexual intercourse with a woman co‐worker, the last contact being 2 weeks before the development of the penile lesion. He denied acquiring any sexually transmitted disease (STD) in the past. There was no previous history of urethral discharge or dysuria and he had not received any antibiotic therapy recently. Examination revealed a pea‐sized, hour‐glass‐shaped, slightly erythematous, warm, tender, and fluctuant abscess on the distal part of the median raphe of the penis (Fig. 1). There was a small opening on the distal end of the abscess through which mucopurulent discharge could be readily expressed. The abscess was not attached to the underlying structures. There was no lymphadenopathy or urethral discharge. The prostate, seminal vesicles and Tyson's glands were normal. The rest of the physical examination was normal. Results of routine laboratory tests on blood and urine were normal. Gram‐stained smears and culture of pus from the abscess did not reveal gonococci or other bacteria. Wet preparations of the pus revealed numerous trichomonads which were identified by their characteristic movement and presence of undulating membrane and flagellae. A venereal disease research laboratory (VDRL) slide test of blood was nonreactive. Examination of urethral scrapings and of the prostatic fluid did not show gonococci or Trichomonas vaginalis . The patient was diagnosed as having a trichomonal abscess of the median raphe and was treated with oral metronidazole, 200 mg thrice daily for 7 days, and by repeated aspiration of pus from the abscess through the opening at its distal end. The discharge disappeared on the fourth day and the swelling regressed completely by the tenth day, but the distal opening where the swelling was persisted, through which a thin probe could be passed for about 15 mm into the median raphe. To prevent reinfection, the affected area containing the opening and the tract in the median raphe were excised. Histopathological study of the excised tissue revealed a canal lined by squamous epithelium and surrounded by inflammatory cells. The patient made an uneventful recovery and when seen 1 month after the surgery, the lesion had completely subsided. Investigation of his sex partner, who was asymptomatic, disclosed the presence of Trichomonas vaginalis in her vagina. She was also treated with oral metronidazole, 200 mg thrice daily for 7 days.