Herpetiform Manifestation of Primary Syphilis: A Case Series

Syphilis is a systemic human infection caused by the spirochete Treponema pallidum (1). T. pallidum is an obligate human pathogen, which is renowned for its invasiveness and immune-evasiveness. Syphilis is divided into stages, based on the clinical findings and corresponding serology (2). Due to its many atypical clinical presentations, syphilis is known as “the great imitator”. However, textbooks often describe the primary lesion as solitary, painless and indurated. This description may mislead inexperienced physicians when syphilis presents atypically. From being almost eradicated, in recent years syphilis has re-emerged in Western countries, mainly among men who have sex with men (MSM) (1). Due to the increase in numbers of infected individuals, it is expected that doctors also will observe an increase in atypical presentations, such as the herpetiform manifestation of primary syphilis presented in this case series.