Secondary Syphilis

A 35-year-old HIV-positive homosexual patient presented to the HIV outpatient clinic with fever, headache, and weight loss. Multiple painless, verrucous, papular skin eruptions, including involvement of the palms of the hands (Figure A), indolent ulcers on the penis shaft and scrotum (Figure B), inguinal lymph node swelling, and yellowish coating on the tongue were striking. The suspicion of acute Treponema pallidum infection was confirmed serologically (TPPA titer: 1:655 360, Western blot: IgM positive, RPR antibody titer: 1:64). Due to the patient‘s HIV coinfection (CD4 cells 286/μl, viral load 230 copies/ml) and headache, lumbar puncture was performed. On the basis of evidence of intrathecal production of treponema-specific antibodies (specific antibody index: 19.66), neurosyphilis was confirmed. Following 14-day treatment with ceftriaxone, rapid improvement of the eruptions was seen.

Figure

A) Clavi syphilitici on the palms of the hands.
B) Chancre on the penis shaft with contact chancre on the scrotum.

In summary, these are typical findings in secondary syphilis with a chancre, lymphadenitis, verrucous exanthema and palmar involvement (clavi syphilitici), mucous membrane involvement (mucous patches), and headache as early signs of neurosyphilis. The incidence of syphilis has increased significantly in Germany since 2010 (2018: 7332 cases). A total of 85% of cases involve males who have sex with other males.

Dr. med. Henning Trawinski, Prof. Dr. med. Christoph Lübbert DTM &H, Interdisziplinäres Zentrum für Infektionsmedizin, Universitätsklinikum Leipzig; Bereich Infektiologie und Tropenmedizin, Klinik und Poliklinik für Onkologie, Gastroenterologie, Hepatologie, Pneumologie, Infektiologie, Universitätsklinikum Leipzig, [e-mail]

Sarah Bußler, Bereich Infektiologie und Tropenmedizin, Klinik und Poliklinik für Onkologie, Gastroenterologie, Hepatologie, Pneumologie, Infektiologie, Universitätsklinikum Leipzig

Conflict of interest statement: The authors declare that no conflict of interest exists

Translated from the original German by Christine Rye.

Cite this as: Trawinski H, Bußler S, Lübbert C: Secondary syphilis. Dtsch Arztebl Int 2021; 118: 249. DOI: 10.3238/arztebl.m2021.0107