case report: urthritis by syphilis

Maurizio Foresio1, Antonio Carrieri1, Angelo D'Elia1, Floriano Beleggia1
  • 1 Ospedale SS. Annunziata (Taranto)


The continued and numerous migration flows in Europe to which we are subjected oblige us to confront now obsolete and no longer endemic diseases for some time.
Recognizing them can help in early diagnosis and appropriate therapy

Materials and Methods

It came under our observation for Urethrorrhagia: Man 20 years from gambia, normal white blood cells, hb reduced to 7.9 g / dl rbc3,01 Hct 25%.
alerted by the patient's origin and asked to investigate the lack of cooperation, for idiomatic reasons, we contacted our colleagues in infectious diseases. they already knew the patient to a tertiary syphilis, positive to the relative test (TPPA). The patient was unhelpful to the previously recommended therapy.


the patient is subjected to HCV,hbv e hiv tests, who test negative, Chest X-ray, CT abdomen-pelvis(to rule out any location of intraparenchymal disease). Chest X-ray is negative. diagnostics for system images nervous is in progress.
CT abdomen pelvis. shows inguinal lymph nodes of 3 cm, palpable on physical examination,And no other goal mark, and Minutes retroperitoneal lymph nodes. The patient has Brought to seven days urethral catheter (c up to interruption of Urethrorrhagia, then removal of the cu, shooting copious Urethrorrhagia hesitated in CV repositioning for Other 3 days, until complete interruption of 'bleeding and then removed. The patient Meanwhile Treaty with the ceftriaxone 2 gr to day, it is transferred to the operative Unit of infectious diseases.


Syphilis in clinical stage I, II, or III is called
“early syphilis” for the first year after the date of infection
and “late syphilis” at later times.
Painless lymphadenopathy develops regionally
Stage III syphilis causes a wide
variety of general medical, neurological, and
psychiatric morbidity and may be life-threatening if
untreated.Between this variety of symptoms acute urethritis with possible bleeding
This case represents an unusual complication of tertiary syphilis
It has been observed that urethral bleeding is more common
in patients with co-infection of syphilis and gonorrhoea,
suggesting that pathological changes to the urethral mucosa ,but it's possible so in III stage ofsyphilis (1,2,3) All persons who have primary and secondary or tertiary syphilis should
be tested for HIV,hbv, hcv infection or for intraperenhimali injury ( with ct)
Patients with late latent syphilis should
receive doses of benzathine
penicillin Ceftriaxone (1–2 g daily) may be effective
for treating early syphilis. However, data are
limited, and the optimal dose and duration of
therapy are not defined ( 4.5)


The clinician should attempt to obtain objective
evidence of urethral inflammation for an adequate therapy


1.The Presentation, Diagnosis, and Treatment
of Sexually Transmitted Infections
Florian M.E. Wagenlehner, Norbert H. Brockmeyer,
Thomas Discher, Klaus Friese, Thomas A. Wichelhaus
2.International Journal of STD & AIDS Volume 22 September 2011
J Penton MBBS BSc and P French FRCP

3.MMWR / June 5, 2015 / Vol. 64 / No. 3
Prepared by
Kimberly A. Workowski, MD1,2
Gail A. Bolan, MD1
1Division of STD Prevention
National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention
2Emory University, Atlanta, Georgia


5.JAOA • Vol 104 • No 12 • December 2004
Nusbaum et al