Rectal Chancre

Primary syphilis of the rectum--endoscopic and clinical features. Report of a case

A 33-year-old man was admitted to our hospital for suspected rectal tumor. Endoscopy showed a rectal mass not typical of carcinoma, and histologic evaluation of biopsy specimens revealed granulomatous inflammation. Venereal Disease Research Laboratories (VDRL) and Treponema pallidum hemagglutination (TPHA) tests became positive during hospitalization, and dark-field examination was positive for Treponemas, thus allowing the diagnosis of chancre of the rectum. The clinical and endoscopic features of this case are described.

Syphilitic proctitis

Two adult male homosexuals with syphilitic proctitis and without any detectable anal lesions are reported. There was no history or evidence of an external primary chancre in either patient. Of note, one had extensive rectal involvement of the first 20 cm and the other had multiple sites involved. One patient developed severe rectal bleeding following biopsy and a Jarisch-Herxheimer reaction after the first penicillin injection. Salient features of the literature are reviewed and discussed.