Atypical manifestations of recent syphilis: study of 19 cases

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.

Atypical Manifestations of Syphilis: A 10-Year Retrospective Study

“…In 1978, Chapel found that less than half (42.7%) of patients with PS he diagnosed presented typical single, indurated chancres with regional lymphadenopathy, suggesting that the “classic” chancre may be the “atypical” lesions [ 15 ]. However, beyond many case report [ 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 ] and narrative review [ 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 ] syphilis manifestations, very few studies and/or case series including more than five cases with atypical syphilis manifestations have been published in the English literature during the past 20 years [ 32 , 33 , 34 , 35 , 36 , 37 , 38 ] ( Table 4 ). Cases of atypical primary syphilis misdiagnosed as pharyngeal lymphoma, tongue cancer, and other types of oral squamous cell carcinomas have been described [ 39 , 40 , 41 ]; however, the secondary stage of the disease, given the possible involvement of the whole skin area and of other organs, is the one that is most prone to misdiagnosis like palmoplantar psoriasis, psoriasis vulgaris, erythema multiforme, cutaneous lymphoma, and granulomatous diseases of the skin (annular granuloma, sarcoidosis).…”

“…The phagedenic chancres have been historically associated with pyogenic superinfections (Streptococcus agalactiae in one of our cases), which cause an extensive loss of substance; in other instances, immunosuppression due to HIV infection and/or alcoholism may cause the loss of local cellular immunity, favoring the massive local diffusion of the T. pallidum infection [ 29 , 38 ]. None of our patients with phagedenic chancres were HIV-seropositive, but one was a heavy drinker and the other used soft drugs.…”

“…In our series, only one of the six patients with psoriasiform syphilis had a family history of psoriasis; however, the simultaneous diagnosis of PS in the partner and complete resolution after treatment confirmed the diagnosis. Psoriasiform SS has been described both in immunocompetent patients and in people living with HIV [ 29 , 38 , 49 ]. This clinical aspect corresponds histologically to a dense mononuclear infiltrate composed of lymphocytes, macrophages, plasma cells, neutrophils, and eosinophils in variable proportions, extending to the deep dermis [ 29 ].…”

Treponema pallidum, an odontological point of view

“…The clinical presentations of syphilis, in all phases, are varied, and most scholars in this area consider it "the great imitator" [29] . This is because the manifestations histologically and clinically mimic a wide variety of infectious, neoplastic and immune diseases.…”