A Rare Type of Balanitis
Syphilis is an old disease and a major public health concern, which is re-emerging in the western world. Atypical syphi- litic presentations can be challenging to diagnose. We present a 23-year-old, HIV-positive man who has sex with men who presented with a 2-week history of an asymptomatic lesion on the glans. Previous topical and systemic treatments proved unsuccessful. Physical examination demonstrated a slightly indurated, ill-defined erythematous plaque over most of the glans. Enlarged, non-tender, bilateral inguinal lymph nodes were palpable. Serological tests revealed a fourfold increase in the VDRL titre (1:8, previously 1:2). A diagnosis of syphilitic balanitis of Follmann was made and complete resolution was achieved with an intramuscular single dose of benzathine penicillin 2.4 MU.
Syphilitic balanitis of Follmann represents an uncommon manifestation of primary syphilis, with less than 100 cases reported. Untrea- ted, it will resolve spontaneously, but the patient will remain highly infectious and at-risk for long-term morbidity. In an era in which the number of syphilis cases is increasing sharply both in Western Europe and the United States, all physicians should be aware for the typical and atypical early syphilitic manifestations as they represent opportunities of paramount importance for treatment and epide- mic control.
Farhi D, Dupin N. Origins of syphilis and management in the immunocompetent patient : Facts and controver- sies. Clin Dermatol. 2010; 28:533-8. doi:10.1016/j. clindermatol.2010.03.011.
Singh AE, Romanowski B. Syphilis : Review with Em- phasis on Clinical , Epidemiologic , and Some Biologic Features. Clin Microbiol Rev. 1999;12:187-209.
Encyclopaedia Britannica [accessed May 2019] Avai- lable from: http://www.britannica.com/EBchecked/ topic/578770/syphilis/253277/Syphilis-through-his- tory.
Centers for Disease Control and Prevention. The Natio- nal Plan to Eliminate Syphilis. Atalanta: CDC; 1999.
Hook EW. Syphilis. Lancet. 2017;389:1550-7. doi:10.1016/S0140-6736(16)32411-4.
Mainetti C, Scolari F, Lautenschlager S. The clinical spectrum of syphilitic balanitis of Follmann : report of five cases and a review of the literature. J Eur Acad Dermatol Venereol. 2016;30:1810-3.doi:10.1111/ jdv.13802.
Abdennader S, Janier M, Morel P. Syphilitic balanitis of Follmann : three case reports. Acta Derm Venereol. 2011;90:191-2. doi:10.2340/00015555-0983.
Copyright (c) 2020 Journal of the Portuguese Society of Dermatology and Venereology
This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.
All articles in this journal are Open Access and meet the requirements of funding bodies or academic institutions. Each article published in the Journal is published under the Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License (CC BY-NC-ND 4.0). Articles can be read, downloaded, printed, and shared.
Submission of an article for publication implies the authors’ consent to publication under the applicable Creative Commons license and the terms and conditions of the Publisher’s Licensing Agreement.
It is the author's responsibility to obtain permission to reproduce illustrations, tables, etc. from other publications.
Upon acceptance of an article, authors will be asked to complete a 'Journal Publishing Agreement'. An e-mail will be sent to the corresponding author confirming receipt of the manuscript together with a 'Journal Publishing Agreement' form or a link to the online version of this agreement.
Author rights: As an author you (or your employer or institution) have certain rights to reuse your work.
The Journal reserves the right to use plagiarism detection software on any submitted material.