Monitoring and Evaluation of Syphilitic Tonsillitis

Abstract

Introduction: Syphilitic tonsillitis is an uncommon extragenital manifestation of syphilis that may clinically mimic chronic tonsillitis or oropharyngeal malignancy, resulting in delayed diagnosis and therapeutic challenges. Long-term monitoring is particularly important among men who have sex with men (MSM) because of the high risk of reinfection. This case report aims to emphasize the importance of comprehensive monitoring and evaluation in assessing therapeutic response and detecting reinfection in syphilitic tonsillitis.

Case Presentation: A 27-year-old bisexual man presented with recurrent sore throat, cervical lymphadenopathy, and persistent tongue lesions. Oropharyngeal examination demonstrated asymmetric tonsillar hypertrophy with irregular friable surfaces, raising suspicion of tonsillar malignancy. Before treatment, the patient had a reactive Rapid Plasma Reagin (RPR) result consistent with syphilis infection. He had previously received oral doxycycline followed by three weekly doses of 2.4 million units of intramuscular benzathine penicillin G. Bilateral tonsillectomy was subsequently performed for diagnostic and therapeutic purposes. Histopathological evaluation demonstrated chronic inflammatory changes compatible with syphilitic tonsillitis. During follow-up, TPHA remained reactive, whereas VDRL became non-reactive after treatment and later demonstrated low-titer fluctuation. Significant clinical improvement was observed despite serological variability.

Conclusion: Syphilitic tonsillitis should be considered in patients with atypical chronic tonsillitis or suspected oropharyngeal malignancy, particularly among high-risk populations. Comprehensive monitoring integrating clinical assessment and serial serological evaluation is essential because treatment response may not always correlate with serological findings.