Session type: What's new
- Saturday, 9 May
- 12:30 - 14:00 EEST
Is it syphilis?
Prof. Electra Nicolaidou (Athens, Greece) delivered an engaging presentation on the diagnostic complexity of syphilis. Through clinical cases, she illustrated how “the great imitator” continues to mimic a broad range of dermatological conditions. Primary syphilis may present with atypical, deep, multiple or painful ulcers, while secondary syphilis can resemble inflammatory, granulomatous, or infectious dermatoses. Cases initially mistaken for discoid lupus erythematosus, nodular prurigo and granuloma annulare were later confirmed as syphilis.
Prof. Nicolaidou also highlighted malignant syphilis, a severe ulcerative form increasingly recognised beyond HIV co-infection and reviewed important differentials including genital herpes, oral candidiasis, seborrhoeic dermatitis and Lipschutz ulcers.
“Clinicians should maintain an elevated suspicion of syphilis, especially in patients with risky sexual behaviour who present with unusual rashes that do not respond to treatment.”
PCR in syphilis diagnosis
Dr. Hana Zakoucká (Prague, Czech Republic) presented on the role of PCR in syphilis diagnosis, positioning it alongside established direct and indirect testing methods. PCR from lesion swabs has demonstrated markedly higher sensitivity than dark-field or immunofluorescence microscopy, particularly in primary syphilis, although performance is substantially lower in non-lesional samples such as saliva, CSF and serum.
Dr. Zakoucká also highlighted the value of site-directed sampling, with PCR detecting extragenital T. pallidum infection at oral and anal sites even in the absence of visible lesions. She shared clinical cases illustrating the role of PCR in confirming syphilitic aortitis and the utility of multiplex PCR for simultaneous detection of multiple sexually transmitted infections in patients with anogenital lesions. She concluded that PCR is particularly valuable in recent, symptomatic syphilis but is not suitable for monitoring treatment response or donor screening.
The “neglected” balanitis
Dr. Carmen Lisboa (Porto, Portugal) presented balanitis as a commonly neglected but diagnostically complex condition in which similar clinical presentations may reflect infectious, inflammatory or pre-malignant disease. Candidal balanitis, the most common infectious cause, was highlighted as frequently over- or underdiagnosed because of its non-specific features, with poorly controlled diabetes, SGLT2 inhibitor use, antibiotic exposure and immunosuppression identified as key risk factors.
Dr. Lisboa also discussed important inflammatory dermatoses, including reactive arthritis-associated circinate balanitis, psoriasis, lichen sclerosus, lichen planus and Zoon’s balanitis. She stressed that chronic balanitis is clinically important due to its association with penile cancer risk and two distinct carcinogenic pathways linked to HPV infection and chronic inflammation. A key takeaway was the importance of sexual history-taking, STI/HIV assessment, dermoscopy and biopsy in persistent or diagnostically uncertain cases.
The clap chronicles: Mutation, resistance and regret
Prof. George-Sorin Tiplica (Bucharest, Romania) opened his presentation by highlighting the growing global burden of gonorrhoea and the accelerating challenge of antimicrobial resistance. He emphasised that asymptomatic pharyngeal and rectal infections act as major reservoirs for silent transmission and resistance development. Resistance has now emerged to every antimicrobial class previously used against gonorrhoea, including ceftriaxone-resistant strains now reported in Europe.
Prof. Tiplica explained that NAAT remains more sensitive than culture, but culture remains essential for susceptibility testing and resistance surveillance. He concluded that emerging first-in-class antimicrobials are important additions to the future therapeutic pipeline.
“Gonorrhoea notification rates in Europe have increased by 321% over the past decade. We have to pay attention to this disease.”
Key takeaways
- Sexually transmitted infections continue to present major diagnostic challenges, with syphilis and balanitis frequently mimicking inflammatory, infectious and pre-malignant dermatoses.
- Rising antimicrobial resistance in gonorrhoea is reshaping STI management, increasing the importance of extragenital testing, resistance surveillance, culture-based susceptibility testing and the development of new antimicrobial therapies.