Introduction Ulcertaive lesions of tuberculosis on penis have been classified as papulonecrotic tuberculids, though clinical presentation and absence of generalised involvement suggest that it is sexually transmitted inoculation tuberculosis.
Methods All patients with penile papulonecrotic tuberculosis (PPNT) presented during past 5 years and their wives were investigated for pulmonary and extra-pulmonary tuberculosis including reproductive tract tuberculosis (RTB). All histopathologically diagnosed patients were treated with anti-tubercular therapy (ATT) and followed up.
Results Seven patients, aged between 21–30 years, all married, were diagnosed with PPNT based on caseating epithelioid cell granulomas in histopathology. They presented with recurrent genital ulcers for the duration ranging from 3–8 years. These would start as asymptomatic papulopustules over the glans penis/prepuce which would breakdown to form painful ulcers in 1–2 weeks and heal with scarring in another 2–3 weeks. Five patients were diagnosed in the past as genital herpes due to episodic nature and received suppressive antiviral therapy without any response. All the patients denied any premarital or extra marital sexual contact or oral insertive sex. A dramatic response was seen in PPNT lesions within 4–8 weeks of starting ATT.
There was a history of primary infertility due to RTB in the spouses of two patients. Spouse of one patient conceived after a course of ATT.
Mantoux test was strongly positive in all, and PCR for Mycobacterium Tuberculosis was positive in 3 patients. HIV serology and VDRL were negative. No internal focus of tuberculosis was found.
Conclusion Several features suggest that penile tuberculide may actually be sexually acquired implantation tuberculosis. The PPNT is an isolated disease without involvement of other parts. The concurrent RTB in the spouse raises the possibility of it being sexually transmitted. With increasing acceptability of oral sex, the inoculation may take place from sputum of a patient with pulmonary TB. This hypothesis needs genotyping studies to confirm.
Disclosure of interest statement None.
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