A Rare Type of Balanitis

  • Bruno Duarte Consulta de Doenças Sexualmente Transmissíveis, Serviço de Dermatologia e Venereologia, Centro Hospitalar Universitário de Lisboa Central, Lisboa, Portugal
  • Ana Rodrigues Consulta de Doenças Sexualmente Transmissíveis, Serviço de Dermatologia e Venereologia, Centro Hospitalar Universitário de Lisboa Central, Lisboa, Portugal
  • Cândida Fernandes Consulta de Doenças Sexualmente Transmissíveis, Serviço de Dermatologia e Venereologia, Centro Hospitalar Universitário de Lisboa Central, Lisboa, Portugal
Keywords: Balanitis, Syphilis, Syphilis, Cutaneous

Abstract

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.

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References

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.

Published
2020-01-11
How to Cite
Duarte, B., Rodrigues, A., & Fernandes, C. (2020). A Rare Type of Balanitis. Journal of the Portuguese Society of Dermatology and Venereology, 77(4), 349-351. https://doi.org/10.29021/spdv.77.4.1107
Section
Case Reports