BACKGROUND: The incidence of syphilis has clearly increased in Germany in recent years. This infectious disease has many forms of manifestation and can imitate surgical diseases.
METHODS: Comprehensive footage of experiences in a proctological center demonstrates these manifestations and explains the correct management.
RESULTS: The likelihood of confusion of syphilis with anal fissures, anogenital warts, proctitis and rectal cancer is high.
CONCLUSIONS: Surgeons can encounter syphilis, the \"chameleon of medicine\" and must know the differential diagnoses.
UNASSIGNED: HINTERGRUND: Die Inzidenz der Syphilis in Deutschland steigt in den letzten Jahren deutlich an. Diese Infektionserkrankung hat viele Manifestationsformen und kann chirurgische Krankheitsbilder imitieren.
METHODS: Reichhaltiges Bildmaterial aus der eigenen Praxis veranschaulicht diese Syphilismanifestationen und erläutert das korrekte Vorgehen.
UNASSIGNED: Bei der Syphilis besteht eine große Verwechslungsgefahr mit Analfissuren, Feigwarzen, Proktitis und Rektumkarzinomen.
UNASSIGNED: Auch ChirurgInnen können dem „Chamäleon der Medizin“ begegnen und müssen die Differenzialdiagnosen kennen.

Syphilis -the \"great simulator\" for classical venereologists-is re-emerging in Western countries despite adequate treatment; several contributing factors have been identified, including changes in sexual behaviour, which won\'t be the topic of this article though. In 2021, a total of 6613 new cases of syphilis were reported in Spain, representing an incidence of 13.9×100 000 inhabitants (90.5%, men). Rates have increased progressively since 2000. The clinical presentation of syphilis is heterogeneous. Although chancroid, syphilitic roseola and syphilitic nails are typical lesions, other forms of the disease can be present such as non-ulcerative primary lesions like Follmann balanitis, chancres in the oral cavity, patchy secondary lingual lesions, or enanthema on the palate and uvula, among many others. Regarding diagnosis, molecular assays such as PCR have been replacing dark-field microscopy in ulcerative lesions while automated treponemal tests (EIA, CLIA) are being used in serological tests, along with classical tests (such as RPR and HAART) for confirmation and follow-up purposes. The interpretation of these tests should be assessed in the epidemiological and clinical context of the patient. HIV serology and STI screening should be requested for anyone with syphilis. Follow-up of patients under treatment is important to ensure healing and detect reinfection. Serological response to treatment should be assessed with the same non-treponemal test (RPR/VDRL); 3-, 6-, 12-, and 24-month follow-up is a common practice in people living with HIV (PLHIV). Sexual contacts should be assessed and treated as appropriate. Screening is advised for pregnant women within the first trimester of pregnancy. Pregnant women with an abortion after week 20 should all be tested for syphilis. The treatment of choice for all forms of syphilis, including pregnant women and PLHIV, is penicillin. Macrolides are ill-advised because of potential resistance.

A 34-year-old immunosuppressed male presented with worsening bilateral lower extremity weakness and urinary retention accompanied by a painless clean-based chancre on his glans penis. Physical examination revealed symmetrically diminished lower extremity weakness most pronounced with hip flexion and knee extension and absent Achilles reflexes. Full MRI spine without contrast was noncontributory. Lumbar puncture showed elevated protein and total nucleated cells with lymphocytic predominance. Both CSF and serum polymerase chain reaction were positive for herpes simplex virus type 2. He received IV methylprednisolone and acyclovir and underwent four months of physical therapy with complete resolution of his neurologic deficits.

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A 18-year-old male presented with ulcers of lips and tongue and erythema of trunk of more than a month duration. Laboratory examinations for syphilis showed that TRUST (+) 1:32, TPPA (+), and HIV antibodies were negative. Combined with his case history and signs, he was diagnosed with secondary syphilis with chancre of lips and tongue and was cured by injecting benzathine penicillin 2.4 million U into gluteal muscles on both sides once a week for three times. After a month, the erythema and chancre disappeared. Three months later, the TRUST test was positive, the titer was 1:8, and the TPPA was positive.

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Syphilis is a sexually and vertically transmitted bacterial infection caused by the bacterium Treponema pallidum. Its prevalence is high in low-income and middle-income countries, and its incidence has increased in high-income countries in the last few decades among men who have sex with men. Syphilis is a major cause of adverse pregnancy outcomes in low-income and middle-income countries. Clinical features include a primary chancre at the point of inoculation, followed weeks later by the rash of secondary syphilis, a latent period, and in some cases, involvement of the eyes, CNS, and cardiovascular systems. It is diagnosed serologically. A single intramuscular dose of long-acting benzathine penicillin is recommended for people who have had syphilis for less than 1 year and longer courses for people with late latent syphilis. Control strategies include screening and treatment of all pregnant women, and targeted interventions for groups at high risk. Vaccine development, research on antibiotic prophylaxis, and digital messaging as prevention strategies are ongoing.

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