Acute periostitis in early acquired syphilis.

A white married man, aged 33 years was treated for penile warts between February and July, 1971. Serological tests for syphilis (WR, VDRL, and RPCF) were negative at his first attendance. He was admitted to hospital on October 1, 1971, for incision of a peri-anal abscess; the serological tests for syphilis were now found to be positive (VDRL titre 1:16) and the erythrocyte sedimentation rate was raised (66 mm./lst hr). About this time he began to experience intermittent pains in both tibiae which were most severe when he was inactive sitting in front of a fire or after a hot bath. Radiographs of the tibiae were inconclusive. Examination in the clinic on December 7, 1971, revealed: (1) An early, faint, macular syphilide on the trunk, arms, and soles of the feet (2) No anal or genital lesions except for a few small penile warts (3) For 10 cm. over the anterior surface of both tibiae a slight pitting oedema of the skin with a small, very localized central area of exquisite tenderness. The pain and the signs of periostitis disappeared within 48 hrs of starting treatment with penicillin and a Herxheimer reaction occurred. The patient's wife was found to be, and to remain, free from syphilis, and it is probable that the infection was acquired homosexually.