Secondary syphilis presenting as annular lichenoid plaques on the scrotum

Background: Secondary syphilis can have protean clinical manifestations and can present with unusual lesions, which may go unrecognized. Methods: We report two cases of secondary syphilis with annular lichenoid plaques on the scrotum associated with generalized lymphadenopathy, fever, and malaise. Results and conclusions: The serology revealed a reactive Venereal Disease Research Laboratory test and a positive Treponema pallidum, hemagglutination assay. The human immunodeficiency virus (HIV) serology was nonreactive. The lesions cleared with a single dose of benzathine penicillin, 2.4 million units, given intramuscularly. The presentations of syphilis, often described as "the great imitator," can be varied and atypical. Increased clinical vigilance and awareness of the varied modes of presentation are needed to prevent missing this highly treatable, potentially serious condition.