non-pruritic scrotal rash

A 30-year-old male came in with a non-pruritic scrotal rash that had been present for two weeks. Sexual history indicated four male partners in the 12 months before the presentation and an episode of unprotected anal intercourse with a casual male partner five months prior. Upon examination, the scrotum revealed several 1mm-diameter grey papules spread symmetrically. Regular, round brown papules that the patient had not noticed were seen on the trunk, back, palms of the hands, and soles of the feet (figure 1). Upon oral inspection, the soft and hard palate had grey lesions that seemed to be mucous patches (figure 2). The nucleic acid amplification testing (NAAT) and serological assays were performed, and the diagnosis was confirmed.