Practice Easily Missed

Syphilitic condylomata lata mimicking anogenital warts

BMJ 2015; 350 doi: https://doi.org/10.1136/bmj.h1259 (Published 17 March 2015) Cite this as: BMJ 2015;350:h1259
  1. F G Bruins, dermatologist-venereologist1,
  2. F J A van Deudekom, resident in internal medicine2,
  3. H J C de Vries, dermatologist-venereologist345
  1. 1Clinic for Dermatology, DermaPark, Uden, Netherlands
  2. 2Department of Internal Medicine, Kennemergasthuis, Haarlem, Netherlands
  3. 3Department of Dermatology, Academic Medical Centre, University of Amsterdam, 1100 DD Amsterdam, Netherlands
  4. 4STI Outpatient Clinic, Public Health Service Amsterdam, Amsterdam, Netherlands
  5. 5Centre for Infection and Immunity Amsterdam (CINIMA), Academic Medical Center, University of Amsterdam, Amsterdam, Netherlands
  1. Correspondence to: H J C de Vries h.j.devries{at}amc.nl

The bottom line

  • Condylomata lata are a cutaneous manifestation of secondary syphilis and can be misdiagnosed as genital warts

  • Prompt diagnosis and treatment with intramuscular benzathine benzylpenicillin are needed to prevent serious neurological complications (such as syphilitic meningitis and cerebrovascular disease), cardiac complications (such as aortic valve destruction), and ongoing transmission

  • Initial diagnostic tests includes an anti-treponemal serological assay and an anticardiolipin test

  • Once condylomata lata are suspected, refer promptly to a specialist centre such as a sexual health clinic or to a (dermato-)venereologist for further investigations (including sexually transmitted infection screen), treatment, contact tracing, and follow-up

A 41 year old man who has sex with men visited our dermatology outpatient clinic with a three month history of non-painful anal papules. He reported protected anal contact with multiple (anonymous) male partners.

Physical examination showed perianal flesh coloured papules with a verrucous surface (fig 1). One papule showed partial ulceration. Our differential diagnosis was between human papillomavirus (HPV) associated genital warts and condylomata lata, a cutaneous manifestation seen in secondary syphilis. On histopathological examination of a lesional biopsy, immunostaining for Treponema pallidum showed a dense plasma-cellular infiltrate and numerous spirochetes. An HPV specific nucleic acid amplification test did not detect viral DNA in the biopsy. The diagnosis was confirmed by serological testing with a T pallidum specific enzyme immunoassay and the Venereal Disease Research Laboratory (VDRL) test; HIV-1 and HIV-2 serology were both …

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