A History Lesson

Unilateral tonsillitis due to primary syphilis with gram-negative corkscrew-like spirochaetes confirmed by Gram stain of pus

“…We initially underestimated the possibility of syphilis because the patient did not have a rash on the trunk or genital area; moreover, the patient did not report the risky sexual behaviour because he did not know the long incubation period of syphilis. Taking a sexual history and keeping syphilis in the differential diagnosis for uncommon pharyngitis are essential 5…”

“…Previous case reports of syphilitic tonsillitis published in English are summarised in table 1 4–10 15–22. Laterality of tonsil and cervical lymphadenopathy are not useful in distinguishing between primary and secondary syphilis (online supplemental table 1).…”

“…Laterality of tonsil and cervical lymphadenopathy are not useful in distinguishing between primary and secondary syphilis (online supplemental table 1). Most case reports did not mention the incubation period, with only one reporting risky sexual activity 6 weeks before the onset of primary syphilis 5. The incubation period of primary syphilis is 10–90 days (mean: 21 days), and that of secondary syphilis is 2 weeks to 6 months (mean: 2–12 weeks) 12…”

“…Syphilitic tonsillitis occurs in both primary and secondary syphilis 4–6. In the absence of skin eruptions, tonsillar syphilis can appear to be tonsillitis caused by another microorganism.…”

“…Unlike group A Streptococcus (GAS), a rapid antigen detection test (RADT) for syphilis or culture has still not been developed. Patients with syphilis tend not to self-report unsafe intercourse 5. Unless serological tests for syphilis are measured, diagnosis of syphilitic tonsillitis tends to be delayed 7.…”