Case report of secondary syphilis in a fifteen year old boy

Syphilis is a sexual transmitted infection caused by a spirochete, Treponema pallidum. We report a case of a fifteen-year-old boy with secondary syphilis. A boy from a poor socioeconomic background presented with a non-healing growth on his penis of about one-month duration. On examination, a condylomata lata was found on the inner aspect of the prepuce, which is a clinical feature of secondary syphilis. He had generalized lymphadenopathy, but had no other clinical features of secondary syphilis.  His Venereal Disease Research Laboratory (VDRL) test titre was reactive at 1:128. The Treponema Pallidum Particle Agglutination (TPPA) test was strongly positive, confirming the diagnosis of a treponemal infection. The recommended treatment of a single dose of benzathine penicillin, 2.4 million units was administered intramuscularly. He did not develop a Jarisch–Herxheimer reaction.  The lesion on his penis healed within a week of treatment. Follow up VDRL titres were 1:8, 1:4, 1:2 and non-reactive at three months, six months, one year and two years, respectively. Though this was clearly a case of child sexual abuse, the legal system could not be activated because the child categorically denied being abused or having any form of sexual contact.