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Case report
A new test for an old foe… spirochaete immunostaining in the diagnosis of syphilis
  1. Martina Toby1,
  2. John White1,
  3. Jon Van der Walt2
  1. 1Genitourinary Department, Guys and St Thomas’ NHS Foundation Trust, London, UK
  2. 2Histopathology Department, Guys and St Thomas’ NHS Foundation Trust, London, UK
  1. Correspondence to Dr Martina Toby, Guys and St Thomas’, Genitourinary Department, NHS Foundation Trust, Westminster Bridge Road, London SE17EH, UK;Martina.toby{at}

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An epidemic of infectious syphilis has emerged worldwide among men who have sex with men (MSM), a condition with myriad manifestations and one that frequently eludes clinicians. Current common diagnostic methods rely on the laboratory detection of antibodies to Treponema pallidum and cardiolipin, the use of dark field microscopy and clinical acumen. Molecular tests are becoming available but are less useful for non-mucosal lesions. We report a recent case of syphilis mimicking a lymphoproliferative disorder where a unifying diagnosis only became apparent when a novel but underused test was employed: the spirochaete immunostain.


A 29-year-old, previously well MSM was admitted to hospital for investigation of 3 weeks of painless bilateral inguinal and cervical lymphadenopathy. He reported malaise, night sweats and joint pain that had started when he was travelling in the Middle East 2 weeks prior. He was apyrexial and routine bloods were normal apart from mildly raised liver enzymes (alanine transferase 69 IU/l (10–35), alkaline phosphatase 149 IU/l (36–126)). Tests done by …

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  • Contributors MT: Original author, compiled haematological data and laboratory investigations, obtained patient consent. JW: Edited article, obtained data on spirochaete immunostain test. JV: Edited article, provided histological advice—compiled histological report, provided histological images for article.

  • Competing interests None.

  • Provenance and peer review Not commissioned; externally peer reviewed.