Abstract

 
 
 
 Syphilis is an old disease and a major public health concern, which is re-emerging in the western world. Atypical syphi- litic presentations can be challenging to diagnose. We present a 23-year-old, HIV-positive man who has sex with men who presented with a 2-week history of an asymptomatic lesion on the glans. Previous topical and systemic treatments proved unsuccessful. Physical examination demonstrated a slightly indurated, ill-defined erythematous plaque over most of the glans. Enlarged, non-tender, bilateral inguinal lymph nodes were palpable. Serological tests revealed a fourfold increase in the VDRL titre (1:8, previously 1:2). A diagnosis of syphilitic balanitis of Follmann was made and complete resolution was achieved with an intramuscular single dose of benzathine penicillin 2.4 MU.
 Syphilitic balanitis of Follmann represents an uncommon manifestation of primary syphilis, with less than 100 cases reported. Untrea- ted, it will resolve spontaneously, but the patient will remain highly infectious and at-risk for long-term morbidity. In an era in which the number of syphilis cases is increasing sharply both in Western Europe and the United States, all physicians should be aware for the typical and atypical early syphilitic manifestations as they represent opportunities of paramount importance for treatment and epide- mic control.
 
 
 
Highlights
Syphilis is an ancient chronic bacterial infection caused by Treponema pallidum, subspecies pallidum
Eradication was even thought to be possible by the end of the 20th century in the United States, and elimination plans by the Centers for Disease Control and Prevention (CDC) were even attempted.[4]
syphilitic balanitis of Follmann (SBF) represents an uncommon manifestation of primary syphilis, with less than 100 cases reported.[6]
Summary
Bruno Duarte[1], Ana Rodrigues[1], Cândida Fernandes1 1Consulta de Doenças Sexualmente Transmissíveis, Serviço de Dermatologia e Venereologia, Centro Hospitalar Universitário de Lisboa Central, Lisboa, Portugal. A resolução completa da lesão foi conseguida com uma dose única intramuscular de penicilina benzatínica de 2,4 M.U. A balanite sifilítica de Follmann é uma manifestação pouco comum de sífilis primária, havendo menos de 100 casos relatados. Syphilitic balanitis of Follmann represents an uncommon manifestation of primary syphilis, with less than 100 cases reported. Untreated, it will resolve spontaneously, but the patient will remain highly infectious and at-risk for long-term morbidity. In an era in which the number of syphilis cases is increasing sharply both in Western Europe and the United States, all physicians should be aware for the typical and atypical early syphilitic manifestations as they represent opportunities of paramount importance for treatment and epidemic control.
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