Immunoglobulin A (IgA) vasculitis, also known as Henoch-Schönlein purpura, is the most common systemic vasculitis in childhood. It primarily affects the skin, joints, gastrointestinal tract, and kidneys. Extrarenal genitourinary manifestations are uncommon, and penile involvement is exceptionally rare, with very few cases documented worldwide and, to our knowledge, none previously reported in Mexico. A previously healthy 10-year-old boy presented with a purpuric rash on the extremities, arthralgia, abdominal pain, and progressive penile edema. Physical examination revealed pharyngeal hyperemia, palpable purpuric lesions on the extremities, an edematous and tender penis, and scrotal papules. Laboratory studies were unremarkable, with no evidence of infectious or autoimmune processes. Testicular ultrasound excluded torsion or other surgical causes. A clinical diagnosis of IgA vasculitis with penile involvement was made, and treatment was initiated with intravenous methylprednisolone followed by oral prednisone, achieving complete resolution without sequelae. Genital involvement in Henoch-Schönlein purpura is rare and may mimic surgical urological conditions. Early recognition of this presentation helps avoid unnecessary interventions. Doppler ultrasound and clinical correlation are essential for diagnosis. In the absence of severity criteria, corticosteroid therapy combined with local supportive measures is usually effective. This case represents the first report in Mexico of Henoch-Schönlein purpura with penile involvement. It highlights the importance of considering this entity in the differential diagnosis of pediatric acute scrotum and demonstrates the effectiveness of conservative management.

Genital psoriasis rarely presents as isolated pustular lesions confined to the glans penis, often leading to misdiagnosis as sexually transmitted infections such as herpes genitalis. We report a 36-year-old male with recurrent pruritic lesions on the glans over four months, with seasonal exacerbations over the past three years, particularly in winter and summer. The patient, with no systemic comorbidities or extragenital lesions, was initially misdiagnosed and treated with antivirals without relief. Clinical examination revealed multiple erythematous papules with collarette of scale and pustules that ruptured to form non-scarring erosions. Histopathological examination confirmed pustular psoriasis. The patient responded completely to topical 2% tofacitinib within four weeks. Isolated genital pustular psoriasis is exceedingly rare, with limited cases reported in the literature. Diagnostic delay is common due to its overlap with other genital dermatoses and lack of typical psoriatic plaques. This case highlights the importance of considering non-venereal causes in persistent genital lesions and the role of histopathology in achieving accurate diagnosis.

Cutaneous angiofibroma is a term used to define a group of lesions with different clinical presentations but with the same histologic findings. They are benign fibrous neoplasms comprised of a proliferation of stellate and spindled cells, thin-walled blood vessels with dilated lumina in the dermis, and concentric collagen bundles. Cutaneous angiofibromas can be located on different areas of the body including the face where they are commonly called fibrous papules or adenoma sebaceum on the penis where they are called pearly penile papules, underneath the nail where they are called periungual angiofibromas or Koenen tumors, and in the mouth where they are called oral fibromas.  Facial angiofibromas are considered one of the most obvious clinical presentations of tuberous sclerosis (TS), an autosomal dominant hamartomatous disorder that affects the skin, kidneys, heart, brain, and lungs. With TS, angiofibromas typically arise on the face in childhood and early adulthood. Both facial angiofibromas (greater than or equal to 3 needed) and periungual angiofibroma (greater than or equal to 2 needed) are 2 of the major criteria for TS. Multiple facial angiofibromas are also found in multiple endocrine neoplasia type 1 (MEN-1) and Birt-Hogg-Dube syndrome. Pearly penile papules are chronic, asymptomatic, papules found on the coronal margin and sulcus of the penis. They are more common in uncircumcised men.[1][2][3]

Human monkeypox (MPX) disease is a re-emerging zoonotic infection caused by the monkeypox virus belonging to the same family as vaccinia and variola. The European Center for Disease Prevention and Control (ECDC) has documented an outbreak of MPX with atypical transmission paths throughout Europe. In this report, male-to-male sexual intercourse was first defined as a means of close humanto-human contact. The Ministry of Health of the Republic of Turkey announced via social media on June 30, 2022 that the first case confirmed by polymerase chain reaction (PCR) for the MPX virus in Turkey was admitted and isolated in a hospital. Four days after this statement, a 24-year-old Turkish man was hospitalized in our clinic with a bacterial infection of the penis and scrotum following local radiofrequency ablation therapy. A week ago, lesions resembling warts were noted in his medical history, for which a local radiofrequency ablation procedure was conducted at an external center. One day after his hospitalization, skin lesions of different stages (from macules, papules to umbilical papules) and several eruptions were detected on his face, nose tip, body, arms, and fingers, which gradually became more evident. After evaluating the risk factors, the patient was isolated with a preliminary diagnosis of MPX disease and samples were collected and sent for MPX virus detection to the reference laboratory according to the Ministry of Health guidelines. MPX virus nucleic acid was detected by PCR in samples taken from the lesion. The patient was discharged after 21 days of isolation and treatment for a secondary bacterial infection. In this case report the significance of differential diagnosis and screening tests for sexually transmitted infections (STI), a previously unreported case of MPX disease in Turkey, and a soft tissue infection that developed after local ablation treatment which was administered to a patient with MPX disease were presented. To be prepared for new and re-emerging infectious diseases, it was emphasized that well-structured continuing education based on current epidemiological data is required. Sexual contact has recently been identified as a new mode of transmission for MPX disease, and symptoms and signs may resemble those of other ulcerative sexually transmitted infections (STIs), such as "molluscum contagiousum" or syphilis. ORF disease is also in the differential diagnosis of MPX disease in Turkey. In addition, patients admitted with unreported STIs are permitted to receive health services without additional screenings. For this reason, easily accessible sexually transmitted disease centers with a high diagnostic efficiency can provide greater control over these diseases.

Monkeypox is a zoonotic illness caused by the monkeypox virus, an Orthopoxvirus in the same genus as the variola, vaccinia, and cowpox viruses. Since the detection of the first human case in the Democratic Republic of the Congo in 1970, the disease has caused sporadic infections and outbreaks, mainly restricted to some countries in west and central Africa. In July, 2022, WHO declared monkeypox a Public Health Emergency of International Concern, on account of the unprecedented global spread of the disease outside previously endemic countries in Africa and the need for global solidarity to address this previously neglected disease. The 2022 outbreak has been primarily associated with close intimate contact (including sexual activity) and most cases have been diagnosed among men who have sex with men, who often present with novel epidemiological and clinical characteristics. In the 2022 outbreak, the incubation period ranges from 7 days to 10 days and most patients present with a systemic illness that includes fever and myalgia and a characteristic rash, with papules that evolve to vesicles, pustules, and crusts in the genital, anal, or oral regions and often involve the mucosa. Complications that require medical treatment (eg, antiviral therapy, antibacterials, and pain control) occur in up to 40% of patients and include rectal pain, odynophagia, penile oedema, and skin and anorectal abscesses. Most patients have a self-limited illness; between 1% and 13% require hospital admission (for treatment or isolation), and the case-fatality rate is less than 0·1%. A diagnosis can be made through the presence of Orthopoxvirus DNA in PCRs from lesion swabs or body fluids. Patients with severe manifestations and people at risk of severe disease (eg, immunosuppressed people) could benefit from antiviral treatment (eg, tecovirimat). The current strategy for post-exposure prophylaxis or pre-exposure prophylaxis for people at high risk is vaccination with the non-replicating modified vaccinia Ankara. Antiviral treatment and vaccines are not yet available in endemic countries in Africa.

We present the case of an HIV-negative man with asymptomatic penile erythematoviolaceous papules associated with similar slightly verrucous papules in the interdigital space of the right foot. A biopsy of the penile lesion confirmed Kaposi's sarcoma. No other causes of immunosuppression were observed. Penile lesions of KS are rare in HIV-negative individuals but it should also be considered in the differential diagnosis. Careful follow-up is recommended.

Chancroid is a rare infection in the United States and many other developed countries. Infrequently identified as a cause of genital ulcer disease, chancroid's atypical presentation has only been reported in approximately 20 cases annually in the United States since 2011. Infection with the causative organism, Haemophilus ducreyi, leads to an erythematous papule that rapidly evolves into a pustule. Infected individuals commonly have more than one ulcer about 2 cm in diameter that is typically noted as painful. The base of the ulcer is usually covered with a gray or yellow purulent exudate and bleeds when scraped. Despite a heavy focus in preclinical medical education, the notably rare chance to see and diagnose chancroid in clinical practice adds to the complicated profile of this infection's identification and subsequent treatment. Such lack of familiarity contributes to reports of accuracy of clinical diagnosis ranging from 30% to 80%.

Chancroid (also known as soft chancre and ulcus molle) is a sexually transmitted disease (STD) due to the Ducrey's bacillus (or Haemophilus ducreyi) characterized by chancre at the site of ulcerated inoculation associated with lymphadenopathy. The disease manifests as a small pinkish papule at the site of penetration of the bacterium. After an incubation period ranging from 24 hours to 15 days (on average 5 days). The lesion rapidly evolves into a more or less extended pinkish, painful, deep ulcer with very inflamed and sharp edges and a ragged appearance. The lymphadenopathies usually occur 2-3 weeks after the contact. They are often unilateral and can evolve into ulcers with pus discharge at the level of the skin. Some complications can occur: penile gangrene, extended gangrene of the skin, local superinfection, association with other sexually transmitted diseases. Bacterium can be identified by microscopic examination of a smear of the chancre-like ulcer, more rarely by fine-needle puncture biopsy of a lymphadenopathy. Giemsa or Pappenheim coloration allows identification of the germ. Treatment is based on azithromycin (1g per os in a single dose) or ceftriaxone (250mg administered intramuscularly in a single dose). We report the case of a 30-year old man with well-defined deep scrotum ulcer with necrotic center which occurred 1 week after unprotected sexual intercourse. Haemophilus ducrey has been detected by culture and the patient underwent Azithromycin therapy with good outcome.

Pearly penile papules (PPPs) are benign, dome-shaped lesions found around the corona of the penis. Despite being asymptomatic and benign in nature, the appearance of PPPs may cause a great deal of psychological distress to both the patient and their sexual partner. While patient reassurance may be the first-line treatment, several other treatment modalities including cryotherapy, electrodessication and curettage, and laser therapy have all been used to treat PPPs in order to achieve a cosmetic outcome that satisfies the patient. Based on the evaluation of the existing literature, ablative laser therapies offer satisfactory cosmetic outcomes with good long-term results.

Chancroid (also known as soft chancre and ulcus molle) is a sexually transmitted disease (STD) due to the Ducrey's bacillus (or Haemophilus ducreyi) characterized by chancre at the site of ulcerated inoculation associated with lymphadenopathy. The disease manifests as a small pinkish papule at the site of penetration of the bacterium. After an incubation period ranging from 24 hours to 15 days (on average 5 days). The lesion rapidly evolves into a more or less extended pinkish, painful, deep ulcer with very inflamed and sharp edges and a ragged appearance. The lymphadenopathies usually occur 2-3 weeks after the contact. They are often unilateral and can evolve into ulcers with pus discharge at the level of the skin. Some complications can occur: penile gangrene, extended gangrene of the skin, local superinfection, association with other sexually transmitted diseases. Bacterium can be identified by microscopic examination of a smear of the chancre-like ulcer, more rarely by fine-needle puncture biopsy of a lymphadenopathy. Giemsa or Pappenheim coloration allows identification of the germ. Treatment is based on azithromycin (1 g per os in a single dose) or ceftriaxone (250 mg administered intramuscularly in a single dose). We report the case of a 30-year old man with well-defined deep scrotum ulcer with necrotic center which occurred 1 week after unprotected sexual intercourse. Haemophilus ducrey has been detected by culture and the patient underwent Azithromycin therapy with good outcome.

Kaposi sarcoma is an angioproliferative disorder that ranges from a single indolent skin lesion to respiratory and gastrointestinal/visceral involvement. Kaposi sarcoma is rare in non-immunosuppressed patients. Nineteen cases of penile Kaposi sarcoma in HIV-negative patients were reported in 2012. We present the case report of a 48-year-old male patient with no previous medical history, who came to our urology clinic presenting a purple-color papule on the penis glans. Lab tests revealed negative serology for HIV, but tissue PCR was positive for human herpesvirus 8. Histopathology examination after lesion excision was compatible with Kaposi sarcoma. No other cutaneous or mucosal lesions were present. Primary Kaposi sarcoma of the penis is rare, but may occur in non-immunosuppressed patients.

Pigmented extramammary Paget's disease (PEMPD) is an uncommon intraepithelial adenocarcinoma and a rare variant of Paget's disease, characterized as a superficial pigmented scaly macule clinically and an increased number of melanocytes scattered between the Paget's cells histologically. So it may be confused clinically and histologically with melanocytic tumors, dermatitis and other dermatoses. Different therapeutic attitudes are required in this case of adenocarcinoma in situ as opposed to melanoma and dermatitis. Condyloma acuminatum (CA) is a common sexually transmitted disease caused by human papilloma virus infection, which is also called as genital warts. In this article, we first reported a case of a 65-year-old Chinese man who had pigmented extramammary Paget's disease complicated with CA. This patient presented with verrucous papules on the scrotum for 3.5 years, infiltrative erythema with itch on the mons pubis for 3 years, and scrotum and penis involved gradually for 4 months. Physical examination showed a 8 cm×10 cm dark red patch on the upper part of the scrotum, penis and mons pubis, as well as few maculopapules and nodules. Histopathologic examination of the lesion on the scrotum revealed a focus of Paget's disease, characterized by the presence of large round cells with abundant pale or granular/dusty cytoplasm, pleomorphic vesicular nuclei and prominent nucleoli (Paget's cells), while the histology of the verrucous lesion was consistent with CA. Immunohistochemistry was performed, which showed diffuse positive staining with CK, CEA, PAS, CK20, EMA, CK7, and Ki-67 (40%), HER2 in Paget's cells and negative with P53, P16, CK5/6, S100, MelanA, HMB45, estrogen receptor, progesterone receptor, and gross cystic disease flid protein 15 (GCDFP15). Human papillomavirus-11 (HPV-11) was positive by genotyping using gene amplification in the lesion of scrotum. According to clinical features and laboratory findings, a diagnosis of PEMPD complicated with CA was made. Local excision of the lesion was performed and sent for histological examination, with all margins clear of tumor. Both aforementioned diseases often occur in the vulva. Even so, it has been rarely reported coexisting of the above two diseases, of which the clinical significance and association are also unclear. In this article, we also reviewed the literature relating to PEMPD, and on this basis, the profile of this disease is discussed including its pathogenesis, clinical manifestation, diagnosis, treatment and advances. Due to PEMPD occasionally accompanied with an underlying carcinoma, it's essential to make an accurate diagnosis. Besides, review of the literature reveals that pigmented variant of Paget's disease could be initially misdiagnosed as melanocytic tumors and other dermatoses unless the entity is considered in the differential diagnosis and additional confirmatory studies are performed.