Nonsyphilitic painless genital ulcer

Penile involvement with tuberculosis (TB) is a rare entity, developing secondary to an endogenous source through contiguous contact, autoinoculation, or hematogenous dissemination or from an exogenous source through epidermal breach. We describe 2 cases in HIV-seropositive and -seronegative patients who presented with the primary complaint of a painless penile ulcer suggestive of a syphilitic chancre from which Mycobacterium tuberculosis was cultured. These cases illustrate unusual presentations of a common disease; in the appropriate clinical and epidemiologic context, TB should be included in the differential diagnosis.