Patient with primary tonsillar and gastric syphilis

Area of Science:

• Infectious Diseases
• Gastroenterology
• Otolaryngology

Background:

• Syphilis, a sexually transmitted infection caused by *Treponema pallidum*, can manifest with diverse clinical presentations.
• Oropharyngeal and gastric lesions are uncommon but recognized manifestations of secondary and primary syphilis, respectively.
• Differential diagnosis of tonsillar and gastric lesions can be challenging, often including malignancies.

Observation:

• A male patient presented with tonsillar enlargement, nausea, and snoring, consistent with an upper respiratory infection.
• Spirochetes were identified in tonsillar smears, and a gastric lesion, initially suspected to be malignancy, was observed.
• The patient reported a history of oral sex, suggesting a potential route of infection.

Findings:

• The tonsillar and gastric lesions were attributed to primary syphilis, likely acquired through oral sex.
• Antibiotic therapy with ampicillin led to the resolution of tonsillar swelling and endoscopic normalization of gastric changes.
• Microscopic examination confirmed the presence of spirochetes in the tonsillar lesion.

Implications:

• This case underscores the importance of considering primary syphilis in the differential diagnosis of tonsillar and gastric lesions, especially in patients with relevant sexual history.
• Gastroscopy is recommended for patients with tonsillar syphilis and concurrent gastrointestinal symptoms to rule out or confirm gastric involvement.
• Both oral and gastric syphilitic lesions can mimic malignant neoplasms, necessitating thorough diagnostic evaluation.