日本性感染症学会誌 Journal of Japanese Society for Sexually Transmitted Infections

Case 1 was a 27-year-old male patient who presented at our department with a chief complaint of swelling in the left inguinal region lasting two to three weeks and left groin pain that developed two to three days prior to presentation. The patient reported having sex with CSW four weeks ago and computed tomography examination revealed multiple lymphadenopathy extending from the retroperitoneum to the left inguinal region, suggesting purulent lymphadenitis. Serum serological tests for syphilis were positive for both RPR and TPLA.

Case 2 was a 46-year-old male patient who reported having sex with CSW two months prior to presentation at our department. One month after intercourse, he developed penile pain and a small painful ulcerative lesion in the coronary sulcus. He visited a doctor who diagnosed him with genital herpes and prescribed antiviral drugs. However, the patient was referred to our department upon exhibiting extension of the ulcerative lesion in the coronal groove on the right side of the glans.

Clinical examination showed that the ulcer was the size of a nail plate and the foreskin was mildly edematous and associated with mild pain. Serum serological tests for syphilis were positive for both RPR and TPLA.

Both cases were diagnosed with primary syphilis and treated using a single dose of 2.4 million units of benzylpenicillin. Rapid improvement of symptoms was observed thereafter.

There are limited opportunities to observe patients with syphilis in clinical practice and this often results in delays in diagnosis. In the current case report, both patients were wrongly diagnosed at the time of first visit which delayed commencement of treatment and necessitated involvement of a general physician.