We report a patient who presented with the suspected diagnosis of syphilis. Clinical findings included a penile ulcer, positive history of syphilis more than 20 years ago, and positive syphilis serology (TPHA, FTA-Abs). A biopsy showed a plasma-cell rich inflammation with granuloma formation. Since a birefractory structure was observed in the biopsy possibly corresponding to a foreign body, the patient's occupational exposure was investigated. Working in the fiber reinforced plastics industry, he was heavily exposed to glass fibre that was even detected on the inside of his underwear. Taking the serological pattern into account that was not consistent with active syphilis, a penile ulcer following a foreign body reaction was diagnosed. This case report demonstrates the difficulties of differentiating foreign body granuloma of the genital region from venereal diseases with granuloma formation.
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