The Great Imitator: Presenting in Urgent Care

Author: Harry Spencer / Editor: Steve Corry-Bass / Codes: AP2, SeC3, SLO1, SLO2 / Published: 17/07/2025

A 38-year-old male presents with fever and a rash and concerns about what he believes are infected haemorrhoids. He has no past medical history.

The patient reports that over the last few weeks he has noticed haemorrhoids when wiping after defecation. They are not painful, he also reports feeling run down and feverish and is worried they may be infected. His GP prescribed a course of oral antibiotics but the patient stopped taking these after developing a rash. The patient has been taking fluoxetine for several years.

The patient is sexually active and has intercourse with male and female partners.

Observations:

• Heart Rate 68 beats per minute
• Blood Pressure 124/83 mmHg
• Respiratory Rate 16 breaths per minute
• Oxygen saturations on room air 98%
• Temperature 36.4°C

On examination:

The rash is prominent on the chest and is noted on the palms of hands and soles of feet. On PR examination there are several large flat warty-lesions surrounding the margin of the external anal sphincter with a moist surface and clear discharge. The lesions are prominent in the flexural folds.

You suspect Syphilis as a cause for the patients presentation.