University of Wisconsin–Madison Medical College of Wisconsin

Follmann Balanitis: An Unusual Case of Syphilis

Milan Patel; Paige Gioia, PA; Pinky Jha, MD

WMJ. 2024;123(2):144-146

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A 33-year-old man presented with suprapubic abdominal pain and small vesicular lesions on the foreskin of the penis. Based on the presentation, he was empirically treated for genital herpes, although the herpes simplex virus swab was negative. He returned to the emergency department 4 months after his initial presentation with worsening symptoms that were consistent with balanoposthitis and cystitis. He was tachycardic and febrile on presentation. He denied any sexual contact for the last 3 months, with previous negative screening tests for sexually transmitted infections. Syphilis was eventually diagnosed during this admission. The incidence rates of syphilis have increased in recent years, and the infection is often undiagnosed given atypical manifestations. Here we present an atypical manifestation of syphilis that was initially misdiagnosed as herpes simplex virus.

Author Affiliations: School of Medicine, Medical College of Wisconsin (MCW), Milwaukee, Wisconsin (Patel); Department of General Internal Medicine, MCW, Milwaukee, Wisconsin (Gioia, Jha).
Corresponding Author: Pinky Jha, MD, Medical College of Wisconsin, Hub for Collaborative Medicine 8th Floor, 8701 Watertown Plank Rd, Milwaukee, WI 53226; phone 414.805.0841; email; ORCID ID 0000-0002-7893-188X
Funding/Support: None declared.
Financial Disclosures: None declared.
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