Syphilitic balanitis of Follmann

Oanţă, A; Irimie, Marius

doi:10.1111/ijd.12068

Cited by 13 publications

(20 citation statements)

References 4 publications

(12 reference statements)

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“…SBF should be considered like chancre as a manifestation of syphilis at the primary stage . Our cases illustrate the great variability in the clinical presentation not only in the secondary or tertiary stage, but also for primary syphilis; confirming the reputation of the disease as the greatest imitator in the dermatological field .…”

Section: Discussionsupporting

confidence: 62%

“…Up to now, less than 100 cases of SBF, where either an erosive balanitis was the only mucocutaneous lesion or balanitis preceded, accompanied or appeared later than chancre . The clinical aspect of SBF is therefore variable and can be erosive or only indurated and scaly (patient 5).…”

Section: Discussionmentioning

confidence: 99%

“…The clinical aspect of SBF is therefore variable and can be erosive or only indurated and scaly (patient 5). Palpable lymph nodes in the groin were often associated with a positive syphilis serology . In 1948, according to Follmann, SBF accounted for 0.3–0.5% of syphilis cases.…”

Section: Discussionmentioning

confidence: 99%

“…However, he assumed a higher incidence due to misdiagnosis in the case of specific balanitis . Since epidemiological data is often lacking, we are not able to determine whether SBF is found more frequently in high risk groups such as men who have sex with men and/or HIV‐positive patients …”

Section: Discussionmentioning

confidence: 99%

“…The pathophysiological mechanisms of balanitis as a primary manifestation of syphilis need to be clarified . Some authors have questioned whether the pathogenic role of TP is exclusive and have hypothesized that fuso‐spirilli, associated with the spirochete may play a role in this clinical presentation .…”

Section: Discussionmentioning

confidence: 99%

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The clinical spectrum of syphilitic balanitis of Follmann: report of five cases and a review of the literature

Mainetti

Scolari²,

Lautenschläger

2016

Acad Dermatol Venereol

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Section: Discussionsupporting

confidence: 62%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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The clinical spectrum of syphilitic balanitis of Follmann: report of five cases and a review of the literature

Mainetti

Scolari²,

Lautenschläger

2016

Acad Dermatol Venereol

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Follmann Balanitis—An Atypical Form of Primary Cutaneous Syphilis

Cubiró¹,

García-Pérez

Puig³

2020

JAMA Dermatol

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A man in his 20s with male and female sexual partners presented with month-long progressive, painful, annular, and scalloped erosions on the glans. He denied urethral discharge or other systemic symptoms. Physical examination revealed edema and oozing erosions on the glans and coronal sulcus (Figure). No enlarged lymph nodes or other cutaneous lesions were present. Screening tests for sexually transmitted infections (STIs) were performed, including herpes simplex virus (HSV) polymerase chain reaction (PCR), bacterial and fungal cultures of swabs from erosive lesions, and serologic tests for HIV and syphilis; all results were negative. Under the initial clinical suspicion of HSV infection, he was unsuccessfully treated with valaciclovir. However, a PCR study of a swab sample was positive for Treponema pallidum. A diagnosis of syphilitic balanitis of Follmann (SBF) was made, and the patient was successfully treated with a single intramuscular dose of benzathine penicillin G, 2.4 mIU.A rare subtype of primary syphilis, SBF accounts for less than 0.5% of cases, 1 and is characterized by exudative, welldemarcated, scattered erosions of the glans and prepuce with or without edema. 2 Some cases have also been described with just dry, dark red induration and desquamative balanitis. 3 A typical primary chancre may precede, accompany, or follow the occurrence of SBF. Concomitantly, lymph nodes may or may not be enlarged, depending on the phase of the disease. 2,4 The diagnostic challenge of SBF, even for experienced dermatologists, is owing to its clinical resemblance to genital herpes or Candida infection, and thus it may be underdiagnosed. Diagnosis is usually made with visualization of spirochetes under dark-field microscopy or following a positive lesional PCR swab finding. Serologic studies may be negative early in the disease, especially when palpable lymph nodes are not detected. 2 When negative, serologic studies should be repeated if there is high clinical suspicion. 2 On the other hand, other pathogens such as Candida, HSV, streptococci, and anaerobes must be ruled out. 2,4 Treatment of SBF requires intramuscular administration of 1 dose of benzathine penicillin G, 2.4 mIU. [1][2][3][4] If left untreated, cutaneous lesions will heal spontaneously, but the disease will progress to secondary, latent, and/or tertiary syphilis; therefore, a high clinical suspicion and early administration of adequate treatment are mandatory. 2

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