A rare presentation of syphilis – as an inflammation of the tonsils – was recently detailed in a case report, highlighting the importance of considering the sexually transmitted infection even when symptoms appear in unusual locations. While traditionally associated with genital sores and, later, neurological or cardiovascular complications, syphilis can mimic a variety of other conditions, leading to delayed diagnosis and potential for further spread. This case, published in Cureus, underscores the evolving ways in which syphilis can manifest and the need for clinicians to maintain a broad differential diagnosis.
The patient, a 33-year-vintage male, presented with sore throat, difficulty swallowing and visibly swollen tonsils. Initial examination and testing didn’t point to common causes like strep throat. It was only after further investigation, prompted by the patient’s history, that syphilis was considered. Syphilis, caused by the bacterium Treponema pallidum, is typically contracted through direct contact with a syphilitic sore, known as a chancre, during sexual activity. Though, the infection can spread beyond the initial site and affect multiple organ systems. According to the Centers for Disease Control and Prevention (CDC), syphilis rates in the United States have been steadily increasing in recent years, with a particularly sharp rise in congenital syphilis – infection passed from mother to baby during pregnancy. CDC Syphilis Fact Sheet
Syphilitic Tonsillitis: A Diagnostic Challenge
The case report details how the patient’s tonsillitis proved to be secondary syphilis, the stage of the infection that occurs if primary syphilis (the chancre) is left untreated. Secondary syphilis can cause a wide range of symptoms, including skin rashes, fever, swollen lymph nodes, and, as this case demonstrates, inflammation of the tonsils. The authors of the report emphasize that syphilitic tonsillitis is an uncommon presentation, making it straightforward to misdiagnose. “The atypical presentation of syphilis as tonsillitis can lead to a delay in diagnosis and treatment, potentially resulting in disease progression and increased risk of transmission,” they wrote. The patient in this case had a history of sexual activity with individuals of unknown health status, which raised the clinical suspicion for sexually transmitted infections.
Diagnosing syphilitic tonsillitis requires a high index of suspicion and appropriate laboratory testing. The standard tests for syphilis include non-treponemal tests (like the rapid plasma reagin or RPR test) and treponemal tests (like the fluorescent treponemal antibody absorption or FTA-ABS test). These tests detect the presence of antibodies produced by the body in response to the infection. In this case, the patient tested positive on both types of tests, confirming the diagnosis. A biopsy of the tonsils as well revealed characteristic signs of inflammation consistent with syphilis.
Understanding the Stages of Syphilis
Syphilis progresses through several stages if left untreated. Primary syphilis, characterized by the chancre, is often painless and may resolve on its own, but the infection remains in the body. Secondary syphilis, as seen in this case, develops weeks to months after the chancre appears and is marked by more widespread symptoms. If secondary syphilis is not treated, it can enter a latent stage, where there are no visible symptoms for years or even decades. However, the infection remains active and can eventually progress to tertiary syphilis, which can cause severe damage to the heart, brain, nerves, and other organs. Mayo Clinic – Syphilis
The increasing rates of syphilis, particularly among certain populations, are a growing public health concern. Factors contributing to this rise include decreased condom use, increased rates of sexually transmitted infections and challenges in accessing healthcare. Public health officials are working to raise awareness about syphilis, promote testing, and ensure access to treatment. Early diagnosis and treatment with penicillin are crucial to prevent the progression of the infection and reduce the risk of transmission.
Treatment and Prevention
Fortunately, syphilis is curable with antibiotics, typically penicillin. The duration of treatment depends on the stage of the infection. In the case of the patient with syphilitic tonsillitis, treatment with penicillin resulted in complete resolution of the symptoms. Follow-up testing confirmed that the infection had been eradicated. However, treatment does not repair any damage that may have already occurred, particularly in the case of tertiary syphilis.
Prevention remains the most effective strategy for controlling the spread of syphilis. This includes practicing safe sex (using condoms consistently and correctly), getting tested regularly for sexually transmitted infections, and informing sexual partners if you have been diagnosed with syphilis. The CDC recommends that all sexually active individuals be screened for syphilis, especially those with multiple partners or who engage in high-risk behaviors. Prenatal screening for syphilis is also essential to prevent congenital syphilis.
This case report serves as a valuable reminder that syphilis can present in unexpected ways. Clinicians should consider syphilis in the differential diagnosis of any patient presenting with unexplained symptoms, particularly those with a history of sexual activity. Increased awareness and prompt testing are essential to prevent the spread of this potentially serious infection.
Disclaimer: This article is for informational purposes only and should not be considered medical advice. Always consult with a qualified healthcare professional for diagnosis and treatment of any medical condition.
The CDC continues to monitor syphilis rates and provide updated guidance on prevention and treatment. For the latest information, please visit their website. CDC – Syphilis
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