Syphilis is known as the “great imitator” because of its polymorphic clinical manifestations. Condyloma lata are an uncommon mucocutaneous manifestation of secondary syphilis, generally localized in intertriginous areas, such as the genitals and anus. Extragenital localization of condyloma lata is considered unusual.
Methods
A case study of extra-genital condylomata is presented. To contextualise the case, a literature review of extra-genital condylomata lata was subsequently undertaken. The authors searched MEDLINE/PubMed, Scopus and Excerpta Medica/EMBASE English-language sources using the following keywords: “condyloma lata”, “condylomata lata”, and “condyloma latum”.
Results
Thirty-five papers (from 1940 to 2021) describing an extra-anogenital localization of condyloma lata were found and are summarized in Table 1. Patients were mainly males (82.1%), with a mean age of 31.9 years. Most of them showed other manifestations of secondary syphilis (53.9%). In a minority of cases (39.0%), concomitant anogenital condyloma lata were present, thus making the diagnosis easier. The toe web localization was the most documented (26.2%) followed by the oral cavity (23.8%).
Conclusion
In the presence of extra-genital condyloma lata, the differential diagnosis is not always clear, especially when no other muco-cutaneous lesions are observed. In the case of eroded or wet lesions involving any cutaneous fold, associated or not with other cutaneous manifestations, a sexual history should be obtained, and syphilis must be considered.
CusiniMRamoniS. The syphilis after the year 2000. In: CristaudoAGiulianiM (eds) Sexually transmitted infections – advances in understanding and management. 1st ed.Basel: Springer International Publishing, 2020.
2.
ForrestelAKKovarikCLKatzKA. Sexually acquired syphilis: historical aspects, microbiology, epidemiology, and clinical manifestations. J Am Acad Dermatol2020; 82(1): 1–14. DOI: 10.1016/j.jaad.2019.02.073.
BalagulaYMatteiPLWiscoOJ, et al.The great imitator revisited: the spectrum of atypical cutaneous manifestations of secondary syphilis. Int J Dermatol2014; 53(12): 1434–1441. DOI: 10.1111/ijd.12518.
5.
FrenchPGombergMJanierM, et al.IUSTI. 2020 European guidelines on the management of syphilis. Int J STD AIDS2009; 20(5): 300–309. DOI: 10.1258/ijsa.2008.008510.
6.
RamoniSPonzianiABoneschiV, et al.Annular secondary syphilis. G Ital Dermatol Venereol2019; 154(1): 93–94. DOI: 10.23736/S0392-0488.17.05627-9.
7.
GrangePAGressierLDionPl, et al.Evaluation of a PCR test for detection of treponema pallidum in swabs and blood. J Clin Microbiol2012; 50: 546–552.
8.
IkedaEGotoASuzakiR, et al.Condylomata lata on the ankle: an unusual location. Dermatol Pract Concept2016; 6(2): 49–51. DOI: 10.5826/dpc.0602a09.
9.
Magdaleno-TapialJHernández-BelPValenzuela-OñateC, et al.Whitish dots provide the key to diagnosing condyloma lata: a report of 5 cases. Actas Dermosifiliogr (Engl Ed)2020; 111(10): 892–895. DOI: 10.1016/j.ad.2019.02.020.
10.
SundararajASWilliamsJGopinathanR, et al.Unusual manifestations of early syphilis in a married male. Florid manifestations of condylomata lata on the face. Int J STD AIDS1995; 6(1): 52–53. DOI: 10.1177/095646249500600112.
11.
NarasimhanMLagooMRamachandranR, et al.Syphilis D’ Emblée: a case series of the great masquerader. J Fam Med Prim Care2022; 11(3): 1216–1220. DOI: 10.4103/jfmpc.jfmpc_997_21.
12.
FiumaraNJGiuntaJLCollinsPS. Nasolabial condylomata lata: report of case. Sex Transm Dis1978; 5(3): 112–114. DOI: 10.1097/00007435-197807000-00006.
13.
SehgalVNRegeVLVadirajSN. Some unusual manifestations of syphilis. Condylomata lata of the face. A retrospective diagnosis. Br J Vener Dis1971; 47: 204–205. DOI: 10.1136/sti.47.3.204.
14.
LalSLebbaiS. Condylomata lata involving face. Indian J Dermatol Venereol1970; 36(5): 201–202.
15.
AstrachanGD. Secondary syphilis: condyloma latum in the nostrils. Arch Derm Syphilol1946; 53: 655.
DaiTSongNJ. An unusual case of oral condyloma lata. Int J Infect Dis2021; 105: 349–350. DOI: 10.1016/j.ijid.2021.02.051.
18.
De SwaanBTjiamKHVuzevskiVD, et al.Solitary oral condylomata lata in a patient with secondary syphilis. Sex Transm Dis1985; 12(4): 238–240. DOI: 10.1097/00007435-198510000-00014.
19.
SharmaPKushwahaRKNyatiA, et al.Oral condyloma lata: a rare case report. Indian J Sex Transm Dis AIDS2021; 42: 178–180. DOI: 10.4103/ijstd.IJSTD_88_19.
20.
LiuZWangLZhangG, et al.Warty mucosal lesions: oral condyloma lata of secondary syphilis. Indian J Dermatol Venereol Leprol2017; 83(2): 277. DOI: 10.4103/0378-6323.191129.
21.
UlmerAFierlbeckG. Images in clinical medicine. Oral manifestations of secondary syphilis. N Engl J Med2002; 347(21): 1677. DOI: 10.1056/NEJMicm020403.
22.
BjekićMIvanovskiK. Condyloma latum on the lower lip as an isolated manifestation of secondary syphilis – a case report. Serbian J Dermatol Venereol2016; 8(1): 45–50. DOI: 10.1515/sjdv-2016-0005.
23.
AndreadisDPoulopoulosAAsimakiA, et al.Condyloma lata: an unusual oral manifestation of syphilis: case report. Oral Dis2014; 20: 26–26.
24.
NamHMParkSYParkK, et al.Condyloma lata of the tongue. Korean J Dermatol2010; 48: 804–806.
25.
FarmkissLShadrickVBraceyT. Condylomata lata of the oral commissure: an unexpected presentation of secondary syphilis. Diagn Histopathol2021; 27: 226–229. DOI: 10.1016/j.mpdhp.2021.02.007.
RosenTHwongH. Pedal interdigital condylomata lata: a rare sign of secondary syphilis. Sex Transm Dis2001; 28(3): 184–186. DOI: 10.1097/00007435-200103000-00011.
28.
ThomasEWBluefarbSM. Early syphilitic lesions mistaken for dermatophytosis. Arch Derm Syphilol1940; 42(1): 11–14. DOI: 10.1001/Archderm.1940.01490130015002.
29.
DexterHT. Interdigital infectious syphilitic lesions simulating dermatophytosis; report of ten cases. Ama Arch Derm Syphilol1951; 63(5): 581–585. DOI: 10.1001/Archderm.1951.01570050039004.
30.
MinkinWLandySECohenHJ. An unusual solitary lesion of secondary syphilis. Arch Dermatol1967; 95(2): 217.
31.
HiraSKVenDD. Condylomata lata of the toewebs: a case report of an unusual manifestation of syphilis. Sex Transm Dis1984; 11(3): 167–168. DOI: 10.1097/00007435-198407000-00010.
32.
TempletonSF. Condyloma latum of the toe webs: an unusual manifestation of secondary syphilis. A report of two cases. Cutis1996; 57(1): 38–40.
33.
LeavensJFurukawaDGatesG. Condyloma latum of the plantar foot: case report of an unusual manifestation of secondary syphilis. Int J STD AIDS2021; 32(14): 1354–1357. DOI: 10.1177/09564624211032798.
34.
El-Saad El-RifaieM. Condylomata lata of the palms: an unusual site. Br J Vener Dis1980; 56: 267–268. DOI: 10.1136/sti.56.4.267.
35.
AlexanianCLeSMaC, et al.Umbilical condyloma lata. Dermatol Online J2019; 25(2): 13030–qt2zf38865.
36.
PavithranK. Solitary condyloma latum on the umbilicus. Int J Dermatol1992; 31(8): 597–598. DOI: 10.1111/j.1365-4362.1992.tb02729.x.
37.
LiuTTTanMGoYS. Condylomata lata of the umbilicus. Singapore Med J1972; 13(6): 321–322.
38.
ThamSNLeeCT. Condyloma latum mimicking keratoacanthoma in patient with secondary syphilis. Genitourin Med1987; 63(5): 339–340. DOI: 10.1136/sti.63.5.339.
39.
PourangAFungMATartarD, et al.Condyloma lata in secondary syphilis. JAAD Case Rep2021; 10: 18–21. DOI: 10.1016/j.jdcr.2021.01.025.
40.
KimJSKangMSSagongC, et al.An unusual extensive secondary syphilis: condyloma lata on the umbilicus and perineum and mucous patches on the lips. Clin Exp Dermatol2009; 34(7): e299–e301.
41.
HuaHZhuXYangL, et al.Multiple condylomata lata: a case report. Int J Dermatol2008; 47(1): 56–58. DOI: 10.1111/j.1365-4632.2007.03309.x.
42.
FiumaraNJ. Unusual location of condyloma lata. A case report. Br J Vener Dis1977; 53(6): 391–393. DOI: 10.1136/sti.53.6.391.
