Secondary Syphilis Without Any History of Primary Infection

A 20-year-old male German student presented with a bilateral speckled rash, most prominent on the palms of the hands. He said the rash did not itch and was getting progressively worse. His family doctor, suspecting a contact allergy, had prescribed him a cortisone cream one week earlier, but this had not led to any discernible benefit. The patient had returned from a three-month stay in the Caribbean three weeks previously and had first become aware of the rash in his last few days there. The remainder of the physical examination was normal, including the mucous membranes and lymph nodes. Laboratory testing revealed a positive treponema pallidum hemagglutinin (TPH) test and a positive 19S-IgM-FTA-ABS test, establishing the diagnosis of secondary syphilis despite the absence of any history of primary infection. This case underscores the importance of thorough history-taking, including a travel history.

Cite this as: Grade M, Bronnert J: Secondary syphilis without any history of primary infection.

Translated from the original German by Ethan Taub, M.D.