Indian J Sex Transm Dis Indian J Sex Transm Dis
Official Publication of the Indian Association for the Study of Sexually Transmitted Diseases
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Year : 2023  |  Volume : 44  |  Issue : 1  |  Page : 89-90

Was that endoscopy necessary?

Department of Dermatology, Complejo Asistencial Universitario De León, León, Spain

Date of Submission06-Jul-2022
Date of Decision25-Oct-2022
Date of Acceptance09-Dec-2022
Date of Web Publication06-Jun-2023

Correspondence Address:
Ruben Linares Navarro
Hospital Universitario De León, C/Altos De Nava S/N, León 24071
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/ijstd.ijstd_66_22

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How to cite this article:
Navarro RL, Sambucety PS, Rodríguez Prieto M&. Was that endoscopy necessary?. Indian J Sex Transm Dis 2023;44:89-90

How to cite this URL:
Navarro RL, Sambucety PS, Rodríguez Prieto M&. Was that endoscopy necessary?. Indian J Sex Transm Dis [serial online] 2023 [cited 2023 Sep 30];44:89-90. Available from:


Lower gastrointestinal syphilis should be suspected in patients with clinical manifestations of anal or rectal ulcers or pain, hematochezia, or mucopurulent secretions, especially if accompanied by lymphadenopathy or a skin rash.[1]

A 55-year-old male presented with diffuse erythematous papules predominantly on the trunk, without the involvement of the palms and soles [Figure 1]. He also referred an anal ulcer of 1 month of evolution, accompanied by a mucopurulent discharge and discomfort on defecation but no fever. The patient denied having receptive anal intercourse.
Figure 1: Diffuse erythematous papules predominantly on the trunk

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Before our consultation, a lower gastrointestinal endoscopy had been performed due to the suspicion of neoplasia. It revealed a slightly raised ulceration smaller than 1 cm in the posteroexternal perianal region [Figure 2].
Figure 2: Low endoscopy revealed a slightly raised ulceration smaller than 1cm in the posteroexternal perianal region

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Serologies for syphilis, HIV, and viral hepatitis were requested. Treponemal and nontreponemal tests were positive, and he was diagnosed with chancre, proctitis, and exanthema secondary to syphilis. The rest of the serologies were negative.

Treatment with intramuscular penicillin G benzathine was prescribed, and the patient experienced resolution of the cutaneous and anal lesions.

Clinical and serological follow-up was performed and showed negative nontreponemal tests. HIV and hepatitis serologies after the end of the window period were also negative. Evaluation of their sexual partners was also indicated.

An adequate sexual history is important, although the patient's denial of risky practices does not always exclude the possibility of a sexually transmitted disease, as in the present case.

Syphilis is known as the great simulator and its presentation as anal chancres or proctitis can generate confusion with other processes such as inflammatory bowel disease or tumor pathology, even leading to requests for endoscopic studies.[2]

Primary rectal syphilis is an entity that has been on the rise in recent years, but despite this, it is underdiagnosed.[3] This causes a delay in its treatment, with the consequent harm to the patient's and public health.

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Conflicts of interest

There are no conflicts of interest.

   References Top

Ferzacca E, Barbieri A, Barakat L, Olave MC, Dunne D. Lower gastrointestinal syphilis: Case series and literature review. Open Forum Infect Dis 2021;8:ofab157.  Back to cited text no. 1
Pisani Ceretti A, Virdis M, Maroni N, Arena M, Masci E, Magenta A, et al. The great pretender: Rectal syphilis mimic a cancer. Case Rep Surg 2015;2015:434198.  Back to cited text no. 2
Díaz-Jaime F, Satorres Paniagua C, Bustamante Balén M. Primary chancre in the rectum: An underdiagnosed cause of rectal ulcer. Rev Esp Enferm Dig 2017;109:236-7.  Back to cited text no. 3


  [Figure 1], [Figure 2]


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