Streptococcus dysgalactiae-associated penile bacterial disease in an elderly man acquired by fellatio: case report and literature review of penile and perianal Streptococcus dysgalactiae in men acquired by anilingus and fellatio.

Streptococcus dysgalactiae subspecies equisimilis (SDSE) is a gram-positive, beta-hemolytic, large-colony-forming bacteria belonging to group C and G streptococci. It can be isolated in the normal flora of human skin, nasopharyngeal cavity, genitourinary, and gastrointestinal tracts. However, SDSE has been the cause of perianal bacterial infections associated with sexual practices. A 67-year-old man developed a penile bacterial infection secondary to SDSE. The infection presented as a painful erythematous patch on his penile distal shaft. He was successfully treated with oral cephalexin 500mg and topical mupirocin 2% ointment twice daily, for ten days. The infection resolved within ten days of treatment. Penile and perianal SDSE bacterial disease has been reported in five men, including the patient in this report. The perianal area was involved in 80 percent (4/5) of men; concurrent infection in the gluteal area was present in two men. The probable route of transmission was oral-anal (two men) or oral-genital (one man). All of the mens SDSE infections completely resolved after treatment with antibiotics. In conclusion, SDSE can cause penile and perianal bacterial disease, perhaps more frequently in individuals that receive unprotected fellatio and anilingus from asymptomatic or symptomatic carriers of the organism in their oropharynx.