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Updated: Sep 5, 2025

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The great imitator, revisited.

Nikhil Oliveira1, Lorraine Joseph Kandathil1, Georgi Tchernev1

  • 1Onkoderma - Clinic for Dermatology, Venereology and Dermatologic Surgery, Sofia, Bulgaria.

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Summary

This case study highlights an unusual primary syphilis presentation initially misdiagnosed and treated with surgery. Prompt diagnosis and appropriate antibiotic treatment led to complete remission of the syphilis and Chlamydia trachomatis infection.

Keywords:
Chlamydia trachomatisGreat imitatorprimary syphilis

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Area of Science:

  • Infectious Diseases
  • Dermatology
  • Urology

Background:

  • Primary syphilis can present atypically, leading to misdiagnosis.
  • Surgical intervention is not a standard treatment for primary syphilis.

Purpose of the Study:

  • To report a case of primary syphilis with an atypical presentation.
  • To emphasize the importance of accurate diagnosis and appropriate treatment for syphilis.

Main Methods:

  • Case report of a 36-year-old male with a recurrent penile lesion.
  • Diagnostic workup included clinical examination, histology, and serological tests.
  • Co-infection with Chlamydia trachomatis was identified.

Main Results:

  • The patient was diagnosed with atypical primary syphilis.
  • Initial treatment with surgery was inappropriate.
  • Successful treatment with doxycycline resulted in complete remission.

Conclusions:

  • Atypical presentations of primary syphilis require thorough diagnostic evaluation.
  • Prompt and correct antibiotic therapy is crucial for managing syphilis.
  • Co-infections, such as Chlamydia trachomatis, should be considered in genital ulcer cases.