A cisgender homosexual male attended the clinic for evaluation of lesions on the perianal region that had first appeared some weeks before. These lesions had been treated using electrocoagulation at another center, with no improvement. The examination revealed erythematous nodules and papules, some of which had an ulcerated surface (Fig. 1A). The physical examination of the rest of the skin revealed a depapillated area on the tongue (Fig. 1B) and a faint maculopapular rash on the trunk, erythematous desquamative papules with Biett collarette on the palms and soles, and 2 adjacent noninfiltrated plaques with an erosive appearance on the glans penis (Fig. 2). The patient did not complain of local or systemic symptoms.
Given the suspicion of secondary syphilis, treatment was with intramuscular benzylpenicillin G benzathine at 2.4 million IU. Serology testing for syphilis using enzyme-linked immunosorbent assay revealed positive titers for IgG and IgM against Treponema pallidum and a rapid plasma reagin value of 1/32. We also ruled out the presence of other sexually transmitted infections based on negative results for urine, pharyngeal, and rectal samples.
Condyloma lata is an uncommon manifestation and sometimes the main and only manifestation of secondary syphilis. It has a characteristic appearance and is often extragenital.
