Secondary Syphilis From Boyfriend

September 14, 2005
Jonathan S. Crane, MD
Jonathan S. Crane, MD

,
Reynold C. Wong, MD
Reynold C. Wong, MD

The widespread eruption of asymptomatic macules and flat, palpable, flesh-colored lesions prompted a 23-year-old woman to consult her physician. The lesions-some of which had dark centers-were concentrated on the patient's face, neck, and upper back; the palms, soles, anal mucosa, and genital areas were clear. The patient denied systemic symptoms. She was seronegative for HIV.

The widespread eruption of asymptomatic macules and flat, palpable, flesh-colored lesions prompted a 23-year-old woman to consult her physician. The lesions-some of which had dark centers-were concentrated on the patient's face, neck, and upper back; the palms, soles, anal mucosa, and genital areas were clear. The patient denied systemic symptoms. She was seronegative for HIV.

Based on the morphology and location of the lesions, Dr Reynold C. Wong of Sacramento, Calif, suspected secondary syphilis. The lesions of this disease vary widely; the presentation can mimic a number of dermatoses, such as pityriasis rosea, drug eruption, viral exanthem, and sarcoidosis, which must be considered in the differential.

The results of this patient's VDRL and fluorescent treponemal antibody absorption tests confirmed the diagnosis of secondary syphilis. She was given 2.4 million units of intramuscular penicillin G benzathine; the rash cleared within 2 weeks. Although the patient's boyfriend had no rash or genital lesions, his VDRL and fluorescent treponemal antibody absorption test results were positive, and he was treated with penicillin.