A diagnosis of syphilis following a radical circumcision for suspected penile cancer

TL;DR

An elderly man diagnosed with syphilis after being referred for suspected penile cancer highlights the importance of considering syphilis in unusual penile lesions.

Contribution

Highlights syphilis as a rare but important differential diagnosis for penile masses in elderly patients.

Findings

A penile mass suspicious for cancer was found to be syphilis on histopathology.

Spirochaetes consistent with syphilis were identified and confirmed by serology.

The case underscores the rising incidence of syphilis and its atypical presentation in older men.

Abstract

We present a case of a 70-year-old gentleman who was referred to our tertiary 2-week-wait penile cancer clinic with a penile mass that was ulcerated, painful and discharging. This was suspicious for penile cancer and a radical circumcision was performed to remove the diseased foreskin en bloc with the lesion that was arising from the inner foreskin. Histopathology did not reveal cancer; however, we identified spirochaetes in keeping with syphilis. This was confirmed on serology. The patient was referred to the genitourinary medicine team and treated with antibiotics. This case demonstrates a rare presentation of genital syphilis in an elderly gentleman initially referred with concerns of penile cancer. Although, rare, especially in this age group, syphilis should be considered as a differential diagnosis in a patient presenting with an ulcerated, discharging, firm penile mass, especially given that the incidence of syphilis has been rising in recent years.

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