A 27-year-old heterosexual cisgender man, with no relevant past medical history, presented with a 7-day history of pain, preputial edema, and purulent urethral discharge. Physical examination revealed a painful, suppurative parafrenular nodule (Fig. 1A).
Direct visualization of the urethral secretion and the parafrenular area showed findings consistent with gonococcal infection (Fig. 1B). Both polymerase chain reaction testing in urine and culture of exudate from the opening of the parafrenular gland detected Neisseria gonorrhoeae sensitive to ceftriaxone. Diagnosis was gonococcal urethritis and tysonitis. Treatment with intramuscular ceftriaxone 500mg led to symptomatic resolution.
Tyson glands are ectopic sebaceous glands located on both sides of the frenulum, with direct communication to the preputial sac. In the literature, there is some terminological confusion with pearly penile papules. Tysonitis is a rare complication of urethritis resulting from the direct spread of infection to the parafrenular glands. Its main cause is infection by N. gonorrhoeae, and antibiotic therapy is usually effective in achieving resolution. Knowledge of the existence of these glands and their anatomical relationship is essential for diagnosis.
