Syphilis: A Forgotten Sexually Transmitted Disease?

CASE REPORT A 17-year-old African-American male presented to the adolescent medicine clinic with the complaint of bilateral inguinal swelling for 3 weeks. Patient denied pain to inguinal area, testicular pain, penile discharge, dysuria, abdominal pain, fever, weight loss, or fatigue. The patient denied history of inguinal hernias or any recent heavy lifting or straining. The only other complaint at the time of visit was a rash to the right chin, right torso, right forearm, and genital area for several days. The patient was seen in an emergency room and the rash diagnosed as contact dermatitis that was due to a change in soap 2 days prior to the rash appearing. Patient was preparing to enter his senior year of high school. He denied tobacco, alcohol, or drug use. The patient had been sexually active and had four lifetime partners, all females. Patient stated he did use condoms with all sexual intercourse. He did have multiple tattoos and denied any international travel. On exam, this patient was noted to have a hypopigmented, raised flat rash to the right lower face and chin, right forearm, right torso, penis, and scrotum (see Figure 1). Lesions were also found on palms and soles. The rash was non-tender and no erythema was noted. The patient also had cervical lymphadenopathy to the left lateral neck with mild tenderness and bilateral palpable axillary nodes that were non-tender. The most significant finding was bilateral 3 cm × 2.5 cm inguinal nodes that were non-tender. FIGURE 1 | Rash associated with secondary syphilis resembling allergic reaction.