Jed is a 42-year-old office worker who presents with a four-day history of painful scrotal rash.

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<p>Jed is a 42-year-old office worker who presents with a four-day history of painful scrotal rash (pictured).</p><p>He has had a fever (37.8°C) with associated malaise for a week.</p><p>He has a past history of chronic scrotal eczema, for which he uses a low-potency topical steroid as needed.</p><p>He had condom-protected intercourse with a casual male partner two weeks previously. He had a negative routine STI screen two months ago.</p><p>On examination, there is hyperkeratosis and lichenification of the scrotal skin, with overlying umbilicated pustules that have coalesced into a cerebriform pattern. There is no other rash.</p><p>There are multiple enlarged, tender inguinal lymph nodes.</p><p>A PCR swab is negative for HSV, chlamydia and syphilis. Serology is negative for HIV, hepatitis C and syphilis, as are chlamydia and gonorrhoea urine and rectal PCRs.</p>

Dr Kate Kelso is a GP and medical editor at Australian Doctor.