An 83-year-old man presented to the hospital with severe pruritus after cycling through multiple emergency visits over the course of a month. Physicians ultimately diagnosed him with secondary syphilis, a rare presentation of the sexually transmitted infection caused by the bacterium Treponema pallidum.
The patient's intense itching prompted dermatological evaluation and serological testing. His blood work revealed positive results for both treponemal and nontreponemal antibodies, confirming syphilis infection. Imaging and additional clinical assessment ruled out other causes of his symptoms.
Secondary syphilis typically manifests with rash, fever, lymphadenopathy, and systemic symptoms within weeks to months of initial infection. Pruritus as a dominant presenting complaint remains uncommon in this disease stage, making diagnosis challenging. The delay in identification reflected the diagnostic difficulty clinicians face when syphilis presents atypically, particularly in elderly patients where other dermatological conditions take priority in differential diagnoses.
This case highlights a resurgence of syphilis diagnoses across multiple demographic groups in recent years. The Centers for Disease Control and Prevention reported increasing rates of primary and secondary syphilis in the United States, reversing decades of decline. Delayed or missed diagnoses allow disease progression and increase transmission risk.
Treatment with penicillin G remains the standard therapy for secondary syphilis. Early recognition and appropriate antibiotic intervention prevent progression to tertiary syphilis, which can involve neurological, cardiac, and ophthalmological complications.
The patient's case underscores the importance of maintaining clinical suspicion for syphilis across age groups and atypical presentations. Serological testing should be considered in any patient with unexplained dermatological symptoms, particularly those with pruritus lacking obvious etiology. Continued medical education regarding syphilis recognition proves essential as incidence increases and presentations