What’s causing this back pain and penile lesions?

A patient’s new low back and shoulder pain, and painless ulcers, point to an otherwise silent infectious source

Jim is a 31-year-old who presents with a one-month history of penile lesions consisting of a few inflammatory oval rings affecting the glans corona and distal shaft (see figure 1). These are minimally itchy.

Jim has also been experiencing pain in his lower back and both shoulders which is unusual for him and cannot be explained by any injuries or triggers.

He has also noted painless oral ulcers, but has not had any fever, rash or lymphadenopathy.

He has tried over-the-counter clotrimazole/hydrocortisone cream for a week which has been of no benefit.

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