- 29 year old MSM
- Recently arrived in Australia to study
- Numerous episodes of unprotected receptive anal sex in Asia
- Presented student health service with 3 weeks of painful anal ulceration
- Referred because of “unusual anal lumps.”
Dark-ground examination: Spirochaetes detected
Tr pallidum PCR positive
HSV-2 DNA detected by PCR
but… HIV negative!
From the UCSF Dermatology Glossary:
“ The word “condyloma” comes from the Greek word meaning “knob.” Any knob-like or warty growth on the genitals is known as a condyloma. The condylomatous lesions associated with secondary syphilis are called “condylomata lata.” Condylomata lata are papular lesions located on the folds of moist intertriginous areas that coalesce to form flat, wartlike lesions, especially around the genitalia and anus.
These broad, moist, highly infectious plaques develop at sites to which Treponema pallidum has disseminated. They may become hypertrophic and form a soft, red, mushroom-like mass 1-3 cm in diameter. In contrast to condylomata accuminata, condylomata lata are more broad-based, have eroded, flat surfaces, and may be lobulated but are not covered by digitate elevations. Examination of surface exudate under darkfield microscopy will reveal typical spirochetes and serologic tests for syphilis (VRDL, RPR) will be positive. ”
Some interesting case reports of secondary syphilis
Rosen T and Hwong H. Pedal Interdigital Condylomata Lata: A Rare Sign of Secondary Syphilis.
Sex Trans Dis 2001. 28(3):184-186
Login required for these two:
Nodular Secondary Syphilis www.medscape.com/viewarticle/451664
Papulosquamous Eruption of the Trunk and Extremities Following a “Spider Bite” on the Penis www.medscape.com/viewarticle/465134
Updated November 2007