Nonhealing Genital Ulcers

REPORT OF A CASE  A 52-year-old married civilian employee of the US Army was stationed in Saudi Arabia from July to December 1991. In November 1991, he noted several erythematous papules on his scrotum and the left shaft of his penis. These gradually grew and ulcerated. He denied fever, malaise, or pain.He reported no sexual contacts during his 5 months in Saudi Arabia and was otherwise in good general health. Rapid plasma reagin results were negative. Therapy for his genital lesions in December 1991 included 7 days of oral penicillin, 21 days of tetracycline, 20 days of sulfamethoxasole and trimethoprim, and a trial of topical corticosteroids. His skin condition steadily worsened through all of these therapeutic trials. Tests performed elsewhere had included a tissue biopsy specimen reportedly nondiagnostic, negative cultures for acid-fast bacilli, and a bacterial culture that yielded Klebsiella pneumoniae. He was reffered for further evaluation.His examination