Secondary Syphilis Reinfection with Suspected Asymptomatic Neurosyphilis


  • Charles Kurnia Mahono Department of Dermatology dan Venereology, Faculty of Medicine, University of Sam Ratulangi, Manado 95115, Indonesia; Department of Dermatology dan Venereology, Prof. Dr. R. D. Kandou, Central General Hospital, Manado 95115, Indonesia
  • Nurdjannah Jane Niode Department of Dermatology dan Venereology, Faculty of Medicine, University of Sam Ratulangi, Manado 95115, Indonesia; Department of Dermatology dan Venereology, Prof. Dr. R. D. Kandou, Central General Hospital, Manado 95115, Indonesia



Syphilis, VDRL, TPHA, reinfection, neurosyphilis


Syphilis, a sexually transmitted disease caused by Treponema pallidum, poses a significant global health threat, with an annual incidence of around 12 million cases, predominantly affecting individuals aged 15-49. Reinfection occurs in 11 out of 120 patients, underscoring the importance of effective management. If untreated, 4-9% of cases may progress to early neurosyphilis, often presenting asymptomatically. We present the case of a 22-year-old male with reddish-brown patches on the face, palms, and soles, along with erythematous papules on the genital region, following a history of recent promiscuity. Physical examination revealed distinctive manifestations, including nickels and dimes on the face, syphilitic roseola, Biett's collarette on the palmoplantar region, and erythematous papules-plaques on the scrotal and penile areas. The VDRL test indicated a titer of 1:32, TPHA test >1:5120, and a non-reactive HIV rapid test. Initiating treatment with a single intramuscular injection of benzyl benzathine penicillin G (2.4 million IU) resulted in successful symptom resolution, accompanied by a four-fold decrease in VDRL titer to 1:8 by the third month. However, a subsequent increase to 1:32, following sexual intercourse in the sixth month, indicated reinfection and raised suspicions of asymptomatic neurosyphilis. The patient received oral doxycycline (100 mg twice daily) for 30 days. Unfortunately, treatment success could not be determined as the patient was lost to follow-up. This case report highlights that elevated VDRL titers signify reinfection, treatment failure, or neurosyphilis. Asymptomatic reinfection is common due to lead-time bias and partial immunity, especially with multiple episodes of syphilis. Early neurosyphilis may coexist with primary or secondary syphilis and is frequently asymptomatic. Continued efforts in monitoring and treatment adherence are crucial for effective syphilis management on a global scale.


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  1. Daili, S. F., Nilasari, H., and Indriatmi, W. (2017). Infeksi Menular Seksual Edisi Kelima, Badan Penerbit Fakultas Kedokteran Universitas Indonesia, Vol. 5, No. 1, 183–186.
  2. Kang, S., Amagai, M., Bruckner, A. L., Enk, A. H., Margolis, D. J., McMichael, A. J., and Orringer, J. S. (2019). Fitzpatrick’s Dermatology 9th Edition, McGraw-Hill Education.
  3. Widaty, S., Soebone, H., Nilasari, H., Listiawan, M., Siswati, A., Triwahyudi, D., Rosita, C., Hindritiani, R., and Yenny, S. (2017). Panduan Praktik Klinis Bagi Dokter Spesialis Kulit Dan Kelamin Di Indonesia, PERDOSKI.
  4. Kojima, N., and Klausner, J. D. (2018). An update on the global epidemiology of syphilis, Current Epidemiology Reports, Vol. 5, 24–38.
  5. Organization, W. H. (2016). WHO guidelines for the treatment of Treponema pallidum (syphilis).
  6. Çakmak, S. K., Tamer, E., Karadağ, A. S., and Waugh, M. (2019). Syphilis: A great imitator, Clinics in Dermatology, Vol. 37, No. 3, 182–191. doi:10.1016/j.clindermatol.2019.01.007.
  7. Kenyon, C., Osbak, K. K., and Apers, L. (2018). Repeat Syphilis Is More Likely to Be Asymptomatic in HIV-Infected Individuals: A Retrospective Cohort Analysis With Important Implications for Screening, Open Forum Infectious Diseases, Vol. 5, No. 6. doi:10.1093/ofid/ofy096.
  8. Kenyon, C., Lynen, L., Florence, E., Caluwaerts, S., Vandenbruaene, M., Apers, L., Soentjens, P., Van Esbroeck, M., and Bottieau, E. (2014). Syphilis reinfections pose problems for syphilis diagnosis in Antwerp, Belgium – 1992 to 2012, Eurosurveillance, Vol. 19, No. 45. doi:10.2807/1560-7917.ES2014.19.45.20958.
  9. Schmidt, R., Carson, P. J., and Jansen, R. J. (2019). Resurgence of Syphilis in the United States: An Assessment of Contributing Factors, Infectious Diseases: Research and Treatment, Vol. 12, 117863371988328. doi:10.1177/1178633719883282.
  10. Santo Raffaele Mercuri, E. M., Cerullo, A., Di Nicola, M. R., Rizzo, N., Bianchi, V. G., and Paolino, G. (2022). Syphilis: a mini review of the history, epidemiology and focus on microbiota, New Microbiologica, Vol. 45, No. 1, 28–34.
  11. Bernardes Filho, F., Rezende, A. L. R. A., and Sousa, M. D. G. de. (2019). Biett’s sign: a hallmark sign of secondary syphilis, Revista Da Sociedade Brasileira de Medicina Tropical, Vol. 52.
  12. Tan, C., and Zhu, W.-Y. (2016). Arthralgia and scaly rashes over the palms and the soles, Brazilian Journal of Infectious Diseases, Vol. 20, 505–506.
  13. Klein, M., Angstwurm, K., Esser, S., Hahn, K., Maschke, M., Scheithauer, S., Schoefer, H., Sturzenegger, M., Wildemann, B., and Weber, J. (2020). German guidelines on the diagnosis and treatment of neurosyphilis, Neurological Research and Practice, Vol. 2, 1–9.




How to Cite

Mahono, C. K., & Niode, N. J. (2023). Secondary Syphilis Reinfection with Suspected Asymptomatic Neurosyphilis. Indonesian Journal of Case Reports, 1(2), 35–38.