Syphilis Cases Surge Globally, Producing Unusual Symptoms Doctors Miss
A rare case of penile swelling caused by syphilis highlights a growing diagnostic challenge as the infection resurges worldwide with an estimated 8 million new cases annually. Clinicians are increasingly encountering atypical presentations of the disease, underscoring the need for updated screening protocols and staff training in healthcare systems unprepared for this resurgence.
Originaltitel: Syphilis‐Associated Penile Lymphedema
A 44-year-old heterosexual man from West Africa presented to the Genitourinary clinic in Malta with a 2-month history of penile swelling. This developed over an initial erosion on the penile shaft, following application of antiseptics. Sexual history was unremarkable. Examination revealed penile lymphedema, bilateral painless inguinal lymphadenopathy and annular plaques with erosions on the distal penile shaft (Figure 1). He had no other mucocutaneous symptoms, was afebrile, and examination of the abdomen and other lymph node stations was normal. Syphilis serology was positive, and Nucleic Acid Amplification Test (NAAT) from penile erosions detected Treponema pallidum, confirming primary genital syphilis. Laboratory testing for other sexually transmitted infections, including HIV, was negative. The patient received intramuscular benzathine penicillin, which resulted in complete resolution of symptoms after 1 month. The global resurgence of syphilis is a public health concern, with an estimated eight million new cases annually [1, 2]. Known as the ‘great imitator’, syphilis can mimic numerous dermatological and systemic conditions. Penile lymphedema is a rare presentation of syphilis and likely results from inflammatory obstruction of genital lymphatics [3]. Differential diagnoses include malignancy, lymphatic filariasis, streptococcal infection, granulomatous disorders and trauma [4]. Awareness of this presentation is important to ensure timely management and partner notification. Amna Elyas: writing – original draft. Valeska Padovese: writing – reviewing and editing. The authors have nothing to report. All patients in this manuscript have given written informed consent for participation in the study and the use of their de-identified, anonymized, aggregated data and their case details (including photographs) for publication. Ethical approval: Not applicable. The authors declare no conflicts of interest. Data sharing is not applicable to this article as no datasets were generated or analysed during the current study.