Background: In older people, syphilis diagnosis might be undervalued due to both clinical conditions and age-related changes that obscure symptom presentation and physician discomfort with sexual history-taking, creating a dual barrier to timely recognition. Methods: Case presentation with literature review. Results: An 80-year-old woman was referred to the Dermatology Department of Cagliari University by her oncologist, with a 2-month history of intermittent episodes of pruritus associated with papular–nodular skin lesion eruptions, accompanied with asthenia, night sweats, and unintentional weight loss, indicative of a paraneoplastic syndrome or an adverse drug reaction. Careful evaluation indicated the need to perform serological testing, which confirmed secondary syphilis (RPR 1:64 and TPHA 1:5120). Specific questioning regarding sexual behaviors pointed out oral and anal intercourse. The 83-year-old husband did not have active lesions at visit but reported a self-healing generalized skin rash, episodes of asthenia, arthralgia, and headache he had never suffered before. Blood tests showed positive RPR 1:64 and TPHA 1:5120. Targeted sexual history assessment disclosed patient’s engaging with commercial sex workers, clarifying the chain of transmission in this conjugal STI case. Treatment with Benzathine penicillin G 2.4 million units IM in a single dose resulted in complete recovery in both patients. Conclusions: The observation highlights the importance of maintaining a high index of suspicion for syphilis even at advanced age. Persistent stigma regarding elderly sexuality should be faced, and targeted interventions are necessary to improve the clinician’s ability to identify STIs in older adults, but also to reduce sexual stigma and taboo persistence in the general population.
Vivanet et al. (Thu,) studied this question.