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Penile mass with a past: Tertiary syphilis presenting as a penile gumma

Year: 2025

Type: article

Abstract: A 46-year-old man presented with a rapidly growing, verrucous penile mass with bilateral inguinal lymphadenopathy, clinically consistent with locally advanced penile carcinoma. He had no history of sexually transmitted infections and negative rapid plasma reagin (RPR) testing. Biopsy demonstrated no malignancy, but immunohistochemistry revealed Treponema pallidum . He was diagnosed with tertiary syphilis and penile gumma. He was treated with penicillin G, though the gumma showed minimal response and surgical extirpation was recommended. This case highlights the limitations of traditional RPR-first screening in syphilis and underscores the importance of a broad differential diagnosis when addressing penile masses. • Tertiary syphilis presented as penile gumma mimicking malignancy. • Penile mass biopsy IHC diagnosed the Treponema pallidum gumma. • Serum testing with RPR was negative. • Use of reverse algorithm testing with antibodies is better in late-stage syphilis.

Source: Urology Case Reports

DOI: 10.1016/j.eucr.2025.103279