Condylomata lata presenting as perineal lobulated masses

An otherwise healthy 20-year-old girl was referred to our department with skin lesions in the perineum of 4 months’ duration. About 4 months previously several papule-like lesions developed in the perineal area including the perianal area which gradually grew in size. The lesions were not painful or pruritic and produced no discomfort. She reported no history of genital ulceration. Physical examination revealed multi-lobulated masses in her perineum including the perianal area forming rubbery, pink, cockscomb-like masses with a smooth, moist, weeping surface (Fig.1A). There were no abnormal cutaneous findings on her palms, soles, trunk or extremities, or any signs of concomitant systemic disease. A chronic inflammatory infiltrates with mature plasma cells and plump endothelial cells lining the dilated blood vessels of the dermis were evident on punch biopsy (Fig. 2A). Spirochetes were identified from the biopsy tissue with the Warthin-starry staining (Fig. 2B) and immunofluorescence (Fig. 2C). A serologic test for infection with the human immunodeficiency virus was negative. Rapid plasma reagin (RPR) testing was positive with a titer of 1:256. In addition, a treponema pallidum particle agglutination assay was positive, and a fluorescent treponemal antibody absorption test was positive for IgG antibodies. The diagnosis of secondary syphilis with condylomata lata lesions was made. The patient was treated with intramuscular penicillin G benzathine, with full resolution of the lesions during a 4-week period (Fig. 3A). On repeat testing over the course of 8 months, her RPR titer had decreased to 1:2.