Gonorrhoea in the median raphe of the penis. Case report and a survey of the literature.

A taxi driver aged 22, who had been married for 4 years, reported at the Swansea V.D. Clinic on June 15, 1959. There was no history of previous V.D. Extramarital intercourse had occurred on June 1, a urethral discharge was noted on June 7, and on June 13 a mark was noticed on the penis which had not been seen before. Examination (June 15). There was a purulent urethral discharge and a discoloured streak (2j" long)-continuous but not uniform-in part of the penile raphe. Smears from pus expressed from a tiny sinus in the streak and from the urethra showed typical intracellular gonococci. When seen again on June 29 the patient said the discharge had stopped on the day after the first attendance and treatment; the proximal end of the streak showed two openings but no pus could be expressed. No urethral discharge was present. On July 15 and 27 much pus was obtained from the small sinus at the distal end of the streak and gonococci were found in it. There was no urethral discharge and the urine was clear on both occasions. Fresh purulent discharge from both urethra and streak was seen on September 16 and gonococci were found in smears from both sites (Fig. 1, opposite). The patient was not seen again until December 30, 1959, when the discharge had recurred after recent marital intercourse. He had an inflammatory phimosis and-for the first time-the streak was tender. For a few days the patient was treated with saline only; on January 12, 1960, gonococci were cultured from the urethral discharge but not from the scanty sinus secretion. On no occasion was urine seen to escape from the streak. On February 15 circumcision and excision of the whole tract was carried out by Mr. J. Glyn Bowen.