A 27-Year-Old Man Comes to the Office Due to a 2-Week

A 27-year-old man comes to the office due to a 2-week history of genital papules that are not painful or pruritic.  Over this period, he has also had fatigue and mild, generalized arthralgia but no urethral discharge or dysuria.  The patient had gonococcal urethritis 3 months ago, which was adequately treated, and tests for other sexually transmitted infections at that time were negative.  He is sexually active with several male and female partners and reports using condoms consistently after the episode of gonorrhea.  Temperature is 37.6 C (99.6 F) .  Physical examination shows a faint, diffuse maculopapular skin rash involving the trunk, extremities, palms, and soles.  There are several enlarged, nontender inguinal lymph nodes.  Genital examination reveals multiple elevated lesions on the scrotum and perineal region.  Histopathologic evaluation of these lesions would most likely reveal which of the following in this patient?

A) Acantholysis with superficial dermal lymphocytic infiltrate
B) Dysplastic spindle cells with viral genome that form vascular channels
C) Intense plasma cell-rich infiltrate with proliferative endarteritis
D) Panniculitis and septal inflammation with multinucleated giant cells
E) Papillomatous epidermal hyperplasia with cytoplasmic vacuolization

Correct Answer:

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