International Journal of Research in Medical Sciences
Gani AHM et al. Int J Res Med Sci. 2023 Oct;11(10):3834-3836
www.msjonline.org pISSN 2320-6071 | eISSN 2320-6012
DOI: https://dx.doi.org/10.18203/2320-6012.ijrms20233042
Case Report
A case report of secondary syphilis with clinical features that should not
be missed
Abdul H. M. Gani*, Naheel I. Seyam
Primary Health Care Corporation, Doha, Qatar
Received: 16 August 2023
Accepted: 13 September 2023
*Correspondence:
Dr. Abdul H. M. Gani,
E-mail: [email protected]
Copyright: © the author(s), publisher and licensee Medip Academy. This is an open-access article distributed under
the terms of the Creative Commons Attribution Non-Commercial License, which permits unrestricted non-commercial
use, distribution, and reproduction in any medium, provided the original work is properly cited.
ABSTRACT
We present a clinical case of a 22-year-old man who had a sore throat for a month. Further examination and history
revealed that he had secondary syphilis, which was confirmed by a positive laboratory test. This case emphasizes the
importance of conducting a thorough history and physical examination to avoid missed diagnoses.
Keywords: Secondary syphilis, Oral syphilis, Differential diagnosis
INTRODUCTION mortality expenses. This report describes a case of
secondary syphilis in a patient who presented with a sore
Syphilis is known for having a strong similar capacity throat and rash, and it encourages primary care
due to its many manifestations, which imitate those of physicians to investigate risk factors and offer sexually
other medical illnesses such as atypical dermatological transmitted infection testing.
conditions in syphilis. 1 Secondary syphilis can pose a
diagnostic challenge due to its distinctive clinical CASE REPORT
spectrum and may present in an unusual clinical pattern. 2
Secondary syphilis typically manifests as cutaneous A 22-year-old Bangladeshi man with no known medical
lesions affecting the skin and mucous membranes with or illness presented with a sore throat for a month. He stated
without genital involvement.3 that the sore throat was accompanied by an occasional
cough and the occurrence of haemoptysis (coughing up
Both secondary syphilis and the more advanced stages of blood). The patient denied having fever, night sweats or
disease have been associated with additional oral syphilis losing weight. He also complained of lesions on his
manifestations, including tonsillar lesions and perioral palms. He was previously from Bangladesh and had been
rash.3 Among sexually transmitted illnesses (STI) that in Qatar for three months.
can cause oral involvement including primary HIV
infection, orogenital herpes simplex, pharyngeal Examination revealed multiple macular lesions at the soft
gonorrhoea, and chlamydia infection.3 The differentials palate (Figure 1) and multiple psoriasiform keratotic
of oral syphilis in non STI include pharyngolaryngitis, papules over the palms (Figure 2) The history and
aphthous ulcer, lichen planus, oral candidiasis, hairy presentation raised the possibility of secondary syphilis.
leukoplakia, erythema multiforme, and squamous cell Sexual history revealed that he had last engaged in
cancer.4 protected sexual intercourse with his girlfriend before
coming to Qatar. He is a heterosexual and denied of
Syphilis patients who do not receive treatment put society multiple sexual partners. He denied any genitourinary
in danger due to the disease's potential to spread across symptoms except a painless rash on his scrotum past few
the population as well as the associated morbidity and
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Gani AHM et al. Int J Res Med Sci. 2023 Oct;11(10):3834-3836
weeks. Examination of the genitalia revealed annular Management
plaques at the scrotum (Figure 3).
Syphilis serology demonstrated a positive Treponema
pallidum particle agglutination test (TPPA) and rapid
plasma reagent (RPR) test result of 1:128. Other STI
screening test including HBsAg, HBC antibody and HIV
serology were negative. Screening for pulmonary
tuberculosis including chest x-ray and the interferon
gamma release assay (IGRA) was negative.
The patient received intramuscular benzathine penicillin
(2.4 megaunits) treatment for secondary syphilis and was
instructed to return in 4 weeks to review the results of a
repeat serological test and evaluate the patient's response
to the treatment. The system at the centers for disease
control (CDC) was updated with notification. He received
advice to notify his sexual partner and to refrain from
sexual activity for at least two weeks. Besides, safe sex
health advice is given.
Figure 1: Multiple macular lesions at the soft palate. DISCUSSION
Syphilis is a Treponema pallidum infection that is a
significant cause of mortality and morbidity. It is
primarily sexually transmitted, although it can also be
passed from mother to child during pregnant. Syphilis is
justified of the moniker "the great pretender" because to
the wide range of multisystem manifestations it exhibits,
despite the fact that there are classic descriptions of its
stages and natural history.3
Syphilis is classified into three stages with variable
presentations. The clinical signs of secondary syphilis
include macular, papular, papulosquamous, annular,
nodular skin, condylomata lata, and others; there are also
mucosal lesions, hair loss, and nail changes.5 Atypical
presentations of syphilis are associated with a high risk of
transmission due to their ability to mimic other skin
diseases, deviate from classic clinical presentations, and
Figure 2: Multiple psoriasiform keratotic papules adopt unique forms.6
over the palms.
Lesions on the palms of both hands in this case (Figure
2), which were primarily characterized by numerous red
spots and scaling, as well as the presence of annular
plaques at scrotum (Figure 3), provided strong clinical
support for the diagnosis of secondary syphilis. The oral
findings, which themselves may have resembled some
other potential oral illnesses, supported skin findings.
Oral manifestations are most common in the later stages
of the disease and are frequently the only clinical sign.
These lesions are distinguished by their high infection
rates and unusual clinical characteristics.7 Lesions of oral
syphilis can be observed in common locations such the
lips, tongue, gingiva and soft palate. Lesions can also
present on the hard palate and labial commissure, which
make up fewer than 5% of the syphilis oral symptoms.8
Syphilis is diagnosed following a combined evaluation of
Figure 3: Annular plaques at scrotum. past clinical history, clinical features, histological
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Gani AHM et al. Int J Res Med Sci. 2023 Oct;11(10):3834-3836
features, and serological tests, as in the present case, due Ethical approval: Not required
to the high degree of variability in test results. The
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ACKNOWLEDGEMENTS 2019;37(3):182-91.
Author would like to thank the PHCC Qatar research
committee for their input and advice on this case report. Cite this article as: Gani AHM, Seyam NI. A case
report of secondary syphilis with clinical features
Funding: No funding sources that should not be missed. Int J Res Med Sci
Conflict of interest: None declared 2023;11:3834-6.
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