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occurrence in a patient with LLS, where there should be a low number of spirochaetes and second, for its recurrence after each BPG administration. To explain the first observation, one should assume a bacterial load abnormally high in a patient with LLS or could speculate that the patient, despite the negative IgM EIA, has recently been reinfected and therefore we were treating a second asymptomatic early syphilis. In fact, in case of reinfection, usually the disease does not start from the first classic manifestations, but from the point to which the first infection has arrived, LLS in our case. However, the patient denied risk sexual intercourse in recent years. Regarding the second observation, one should assume that despite the destruction of part of spirochaetes, BPG was unable to reduce their population to a level that prevented other episodes. Incidentally, this may cast some doubts on the BPG efficacy in reaching treponemicidal levels in all body districts, especially in late syphilis, when treponemes divide more slowly and require longer penicillin exposure. A recurrent JHR has never been reported in syphilis whereas it was described in a coxiella burnetii infection. In our patient, the corticosteroid pre treatment only mitigated but not suppressed JHR symptoms, confirming previous reports.
Journal of the European Academy of Dermatology and Venereology JEADV