Secondary syphilis with exclusive peno-scrotal localization.

Syphilis is a sexually transmitted disease, caused by Treponema pallidum subspecies pallidum, its incidence, in the last decade, has significantly increased both in Western World and in developing countries. It represents a global health problem: it is estimated that each year the new cases of syphilis account for about 12 millions. The diagnosis is not always easy, especially in secondary syphilis in which the cutaneous manifestations are quite variable and should be considered in the differential diagnosis. A 26-year-old homosexual man had from some days papular lesions in the scrotum and penis. Four months before he had consulted a surgeon for the presence of an ulcerated nodular lesion in the perianal area, which advised to remove it in the suspicion of cancer. The patient declined surgery while observing in the following weeks a gradual and complete disappearance of the lesion. On the basis of clinical history, clinical features and laboratory results, a diagnosis of secondary syphilis with an exclusive peno-scrotal localization was made and systemic therapy with diaminocillin was started that led to complete resolution of skin lesions and to significant reduction of sierologic values.