SDPA Fall | Live Blog | Male Genital Disease
Joseph English III, MD began his lecture with the statement that “not all male anogenital disease is sexually related.” He also stressed that it is important to note that anogenital disease can be a marker of systemic disease. Throughout Dr. English’s lecture he repeated that you must examine the anterior and posterior portion of the patient with the statement “if it is in the front, look in the back”, and when performing full physical exams the foreskin must be retracted in patients who are uncircumcised.
Dr. English recommended utilizing the mnemonic FAINT with Psoriatic Balanitis – Fixed drug eruption or drug reactions, Allergic/irritant/other inflammatory diseases, Infection, Neoplasia, Trauma and Psoriatic Balanitis when approaching anogenital exams of male patients.
For infections, Dr. English focused on sexually transmitted infections. In addition to the painless chancre presentation in syphilis, he reviewed patchy facial hair loss as a less common presentation of syphilis. Dr. English recommends a full work up of these patients to include HIV, RPR, Hep B/C and GC/CT urine PCR as it is not uncommon for these patients to have a dual diagnosis. He stated that it is essential to keep in mind the oncogenic potential of HPV/genital warts through the malignant transformation to squamous cell carcinoma in situ. The vaccine Gardasil 9 has revealed the best protection against the oncogenic strains of HPV. Furthermore, HIV positive patients may present with more severe forms of disease.
In addition to HPV as a cause of neoplasia of the penis, Dr. English also covered additional risks that include phimosis, inflammation, trauma, smoking, HIV and HPV. An uncommon neoplastic presentation of the anogenital region is extramammary paget’s disease, which can often be associated with an underlying malignancy.
Finally, Dr. English discussed lichen sclerosis et atrophicus and the unfortunate delay in diagnosis of these patients which can lead to urethral strictures. The approach to these patients is typically interdisciplinary with urology and sometimes requires surgical intervention.
Byline: Sarah Patton, PA-C, MSHS
Posted: November 5, 2016