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Syphilitic lymphadenitis clinically and histologically mimicking lymphogranuloma venereum

Annesu Wessels, Colleen Bamford, David Lewis, Markus Martini, Helen Wainwright


An inguinal lymph node was discovered incidentally during surgery for a suspected strangulated inguinal hernia. The patient had recently been treated for candidal balanoposthitis and was known to have a paraphimosis. A new foreskin ulcer was discovered when he was admitted for the hernia surgery. The lymph node histology showed stellate abscesses suggestive of lymphogranuloma venereum (LGV). Chlamydial serologic tests were negative. As the histological appearance and clinical details provided were thought to suggest LGV, tissue was also sent for a real-time quadriplex polymerase chain reaction assay. This was used to screen for Chlamydia trachomatis in conjunction with other genital ulcer-related pathogens. The assay was negative for C. trachomatis, but positive for Treponema pallidum. Further histochemical staining of the histological specimen confirmed the presence of spirochaetes. 

Authors' affiliations

Annesu Wessels, Groote Schuur Hospital, Cape Town, South Africa

Colleen Bamford, Division of Microbiology, Faculty of Health Sciences, University of Cape Town, South Africa

David Lewis, Western Sydney Sexual Health Centre, Australia; University of Sydney, Australia

Markus Martini, Department of Surgery, Victoria Hospital, Cape Town, South Africa

Helen Wainwright, Division of Anatomical Pathology, University of Cape Town, South Africa

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Sexually transmitted diseases; Syphilis; Lymphogranuloma venereum; Chlamydia trachomatis; Treponema pallidum; Stellate microabscesses; lymphadenitis; phimosis; strangulated inguinal hernia

Cite this article

South African Medical Journal 2016;106(5):465-467. DOI:10.7196/SAMJ.2016.v106i5.8723

Article History

Date submitted: 2014-08-04
Date published: 2016-04-19

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