Syphilis resurgence: Exploring the impact of COVID-19 pandemic.

Indian Journal of Sexually Transmitted Diseases and AIDS Volume 44, Issue 1, January-June 2023 95 stated that PKMB evolves into four stages: (i) the initial plaque stage, (ii) late tumor stage, (iii) verrucous tumor on the plaque, and (iv) transformation to SCC and invasion. Thickness of the plaque can be sometimes quite huge that the lesion appears as a penile horn. Hyperkeratotic plaques involving perimeatal skin can cause multiple urinary streams on micturition giving an appearance of a “watering‐can penis.” Histopathological examination demonstrates hyperkeratosis, parakeratosis, acanthosis, elongated rete ridges, and mild lower epidermal dysplasia with a nonspecific dermal inflammatory infiltrate composed of eosinophils and lymphocytes.[1] Differential diagnoses include penile horn, penile psoriasis (early plaque stage), giant condyloma, verrucous carcinoma, erythroplasia of Queyrat, SCC, and keratoacanthoma. Chaux et al.[4] studied 74 penile intraepithelial lesions using a triple immunohistochemical panel (p16/p53/Ki‐67) and found a distinctive immunohistochemical profile for associated and precursor penile epithelial lesions. All patients with squamous hyperplasia were p16 and p53 negative, and patients with high‐grade penile intraepithelial neoplasia (basaloid and warty patterns) were consistently p16 and p53positive and variably Ki‐67 positive. Treatment options include topical measures such as 5‐fluorouracil, podophyllin resin, and steroids and physical measures such as cryotherapy, radiotherapy, and wide local excision.[5]