# 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.

## Key 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.