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Case Reports
. 2020 Sep-Oct;95(5):589-593.
doi: 10.1016/j.abd.2020.03.008. Epub 2020 Jul 15.

Atypical manifestations of recent syphilis: study of 19 cases

José Carlos Sardinha  1 , Livia Lima de Lima  1 , Marcel Heibel  2 , Antonio Schettini  3 , Sinesio Talhari  1 , Carolina Talhari  4
Affiliations
Case Reports

Atypical manifestations of recent syphilis: study of 19 cases

José Carlos Sardinha et al. An Bras Dermatol. 2020 Sep-Oct.

Abstract

Background: Syphilis is one of the most common diseases that start with genital ulcers. Aside from the initial, classic ulcerative lesion of syphilis, called hard chancre, atypical presentations are common, with erosions, erythema, edema, balanitis, and other dermatological manifestations. Associated with initial genital lesions, the presence of inguinal adenopathies is frequent, and the presence of hardened and painless lymphangitis on the dorsum of the penis is rare.

Objectives: To describe atypical penile manifestations in patients with early syphilis.

Methods: The present study reports patients who developed cord-like lesions on the penis.

Results: The study included 25 patients with cord-like lesions on the penis; in 19 of those, the diagnosis of syphilis was confirmed.

Study limitations: Small number of patients included.

Conclusions: In view of the findings of the present investigation, it is important to emphasize that all patients who present with cord-like lesions on the penis must undergo a rapid test for syphilis, VDRL, serologies for HIV viral hepatitis B and C and, whenever possible, histopathological and Doppler exams.

Keywords: Syphilis; Syphilis, cutaneous; Treponema pallidum; Treponemal infections.

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Figures

Figure 1
Figure 1
(A) Recent syphilis. Cord-like lesion (VDRL 1:128). (B), Notice the large-volume painless adenomegaly.
Figure 2
Figure 2
Recent syphilis. Cord-like lesion and shallow, clean ulcer.
Figure 3
Figure 3
Cord-like lesion and underlying shallow ulcer along almost the entire indurated area. Notice the secondary lesions in the hand and glans.
Figure 4
Figure 4
Hyperkeratosis and regular acanthosis of the epithelium. In the chorion, lymphoplasmacytic infiltrate surrounding superficial vessels (Hematoxylin & eosin, ×100).
Figure 5
Figure 5
Immunohistochemistry − Patient # 1. Positive for Treponema pallidum.
See this image and copyright information in PMC

References

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