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Syphilis is a sexually transmitted infection caused by the spirochaete Treponema pallidum. Syphilis re-emerged worldwide in the late 1990s, and hereafter increasing rates of syphilis were seen also in Denmark. Currently, around 700 cases are diagnosed yearly in Denmark, and syphilis is mainly encountered among men, who have sex with men. However, because of the risk of congenital infection screening of pregnant women has been introduced. Syphilis gives rise to highly variable symptoms such as chancre, skin rashes and fever or latent infection. The recommended treatment is intramuscular administration of penicillin.

We report a case of a 45 year-old bisexual male with multiple enlarged cervical and inguinal lymph nodes. Malignant lymphoma was suspected. Initial fine needle aspirations and the following extirpation of a cervical lymph node revealed severe chronic inflammation. However, thorough blood screening was positive for syphilis. No lesions were found in the mouth, throat or anogenital region. The man was diagnosed as having secondary syphilis, and responded well to treatment with intramuscular benzathin penicillin.

The incidence of syphilis in Denmark is rising. In 2010, 377 new cases of syphilis were reported, 36 of these cases in women. Since January 1st 2010 all pregnant women are offered an antenatal syphilis test. This resulted in the finding of seven cases of syphilis among pregnant women in 2010. This article summarises the clinical and serological findings in syphilis and describes the treatment of the disease, with focus on pregnancy and congenital infection.

Syphilis is still a serious disease with diagnostic difficulties. In the present clinical case a patient had a routine serology screen for syphilis and HIV at a venerology clinic. He had previously presented with anogenital tumors, but the diagnosis was uncertain. A polymerase chain reaction (PCR) analysis was performed in addition to serology, and the diagnosis of syphilis in the secondary stage was confirmed. This case demonstrates how PCR technology can assist in the diagnosis of syphilis at early stages and underlines the importance of syphilis screening in homosexual men presenting with anogenital complaints.

Syphilis has increased in Denmark and this "great imitator" disease is easily overlooked. Two case stories are presented; one case illustrates how a patient with classical symptoms of secondary syphilis was overlooked by doctors of several specialities for one year, and the other case is of a patient with a lesion on the penis presenting clinically, serologically and histologically as a syphilitic chancre, but it proved to be a rare chronic inflammatory condition known as a pseudotumor. It is emphasized that doctors in all specialities should increase their awareness of this disease.