Background/introduction Generalised lymphadenopathy and fatigue have a broad differential diagnosis ranging from curable infections to lymphoma. Certain diagnoses can be delayed or missed altogether when patients do not present to sexual health clinics.

Aim(s)/objectives Highlight secondary syphilis as a cause of lymphadenopathy amongst non-sexual health colleagues. Expand syphilis testing beyond sexual health clinics, even in the absence of classical risk factors.

Methods Case report of secondary syphilis which was misdiagnosed despite numerous investigations in primary and secondary care.

Results A 23 year Caucasian lady was referred to lymphoma clinic by her GP with a three month history of lymphadenopathy and fatigue. She was diagnosed with a primary CMV infection and lost to follow up after her symptoms resolved. One year later she attempted to donate blood. Positive syphilis serology with a low RPR was detected on routine blood screening by the transfusion service. The patient was referred to Bristol Sexual Health Centre where sexual history taking revealed she had a bi sexual partner at the time of her illness who also tested positive for syphilis. An archived blood sample from the time of her illness revealed active syphilis infection with a high RPR.

Discussion/conclusion Secondary syphilis can mimic numerous illnesses. However syphilis testing remains uncommon outside of sexual health clinics for a variety of reasons. A change of culture is required to ensure medical professionals are prepared for routine sexual enquiry and consider syphilis as a potential cause for lymphadenopathy.