A 51-year-old man presented with three erythematous perioral papules, each with a shallow central concavity (figure). The lesions resembled keratoacanthoma or molluscum contagiosum. Clinical examination revealed enlarged submandibular lymph nodes with no further cutaneous abnormality. The patient denied prior disease, specifically HIV infection, and high-risk sexual contacts. Diagnostic work-up for sexually transmitted infections confirmed early syphilis; HIV serology was negative, as were urine tests for gonococci, chlamydiae, and mycoplasmas. Histological examination showed a plasma-rich infiltrate with immunohistochemical demonstration of intraepidermal spirochetes. On closer questioning the patient reported oral sexual contact with men. The treatment recommended in the current guidelines (benzathine benzylpenicillin i.m.) led to rapid resolution of the patient’s fatigue and lymphadenopathy and gradual regression of the papules. Extragenital primary effects of syphilis can occur in many different parts of the body and typically manifest as painless ulcerations with an indurated margin (chancre). Molluscoid primary effects are a complete clinical rarity and have not been described in the literature. The presence of multiple papules could be explained by the patient’s customary wet shaving, with even minuscule injuries serving as portals for infection.
Figure.
Translated from the original German by David Roseveare.
Cite this as: Hartschuh W, Durani BK, Toberer F: Perioral molluscoid papules as a manifestation of primary syphilis.
Footnotes
Conflict of interest statement:
The authors declare that no conflict of interest exists.