Differential diagnosis errors of syphilis

Abstract

Syphilis, a sexually transmitted disease, caused by Treponema pallidum. It is often referred to as the “great imitator” due to the wide spectrum of clinical manifestations. This disease advances through different stages: primary, secondary, and tertiary. This review focuses on the diagnostic challenges of syphilis, in particular the primary and secondary stages, comparing clinical overlaps and differences presented. In primary syphilis, the presence of a painless genital chancre is often misdiagnosed for genital herpes, chancroid, or other ulcerative lesions. In addition to primary genital presentations, in some cases, syphilis can also present with oral lesions. These are difficult to distinguish as they overlap clinical similarities with HPV, HSV, aphthous ulcers, squamous cell carcinoma, and traumatic ulcers. Primary syphilis often goes unnoticed and progresses into secondary syphilis. This stage causes systemic symptoms and rashes typically seen in the palms and soles. Differentiating secondary syphilis from other dermatological conditions such as pityriasis rosea, tinea versicolor, lichen planus sarcoidosis, and drug eruption, is crucial for accurate diagnosis. Misinterpretation of syphilis allows the disease to advance to more severe stages without therapeutic interruption, hence why it is important to diagnose syphilis at an early stage through clinical and accurate diagnostic testing.