Four Cases Report Of Secondary Syphilis With Unusual Anifestations And Literature Review

Objective: Recently, the incidence of syphilis is increasing year by year. Clinicalfeature of secondary syphilis is polymorphic which can imitate many diseases. Inaddition, patients often conceal their sexual contact history, So secondary syphilis isoften misdiagnosed as other diseases.We should deepen the understanding of the varietyof syphilis rash, especially unusual manifestations of secondary syphilis. Early detection,early diagnosis and regular treatment is important for the control of syphilistransmission.Methods:This paper reported four cases of rare lesion of secondary syphilisadmitting in our hospital, two cases of tinea-like annular erythema, one single oral ulcer,one case of psoriasis-like scaly papules.Case1A tinea-like annular erythema. A21-year-old female went to seedermatologist for only annular erythema with scaling on the face for sixmonth,accompanied with no itching and other symptoms and signs of syphilis. The rashappeared on her left eyebrow, left mouth with border clearance, slightly elevated. Shewas misdiagnosed as tinea, treatment with Miconazole externally was invalid. Sheadmited the heterosexual contact history, with genital ulcers one year earlier.A fungalsmear microscopy at lesions was negative and syphilis serology text revealed positive.Secondary syphilis was diagnosed. After three times of benzathine penicillin treatment,the lesions resolved completely.Case2Another tinea-like annular erythema. A28-year-old male was adimittedfor erythema and papules of whole body without itching for four days. The lesions werescattered on face, trunk, palms and soles.We can see annular erythema on his face withpink central. There was an ulcer on the penis. He admited the heterosexual contacthistory.A fungal smear microscopy at lesions was negative and syphilis serology textrevealed positive. The case was diagnosed as primary syphilis and secondary syphilis. Patient developed a Jarisch-Herxheimer reaction after firstly treated with benzathinepenicillin,genital ulcer healed after1week, the lesions completely resolved two monthslater.Case3A single oral ulcer. A47-year-old female was admitted for single oralulcer difficult to heal. The anterior arch bing congestive redness, there was a2cm*1.5cm size of the ulcers with clear edge, cleanings surface. She was misdiagnosed asrecurrent aphthous stomatitis, general antiinflammatory treatment was invalid. Asyphilis serology text revealed positive. Secondary syphilis was diagnosed. After twoweeks of ben-zathine penicillin treatment, the mouth ulcer healed.Case4A psoriasis-like scaly papules. A19-year-old female was admitted forgenital ulcer and erythema papules of whole body with mild pruritus for5days. Thelesions were scattered on face, trunk, limbs, overlying silver-white scales, spottingpositive. There was an ulcer on vulva. Previously she has psoriasis with the rash onlyconfined to both legs, but the rash draged in whole body this time. She wasmisdiagnosed as psoriasis, generally treatment was ineffective. She admited the historyof sexual contact and syphilis serology text revealed positive. The case was diagnosedas primary and secondary syphilis. After ten days of ben-zathine penicillin treatment,the vulva ulcer healed, the lesions completely resolved three months later.Conclusion:1. Secondary syphilis is easy to be misdiagnosed for varied clinical manifestations,such as tinea-like annular erythema，only single oral ulcers damage, psoriasis-likescaly papules.2. When the clinical manifestations are not typical and treatment was ineffective,we should think about the possibility of secondary syphilis, further question the patient’shistory of sexual contact and do syphilis serology text timely.3. Benzathine penicillin is still the first choice for treatment of syphilis,the lesionsof syphilis can subside quickly.