83-year-old man married 50 years nearly stumps doctors with surprise STI

Syphilis can be a tricky disease to diagnose—especially when a patient may not be sharing the whole story.

Doctors in Belgium met with a real head-scratcher when an 83-year-old married man came in with a rare form of secondary syphilis—the second of four stages of the sexually transmitted bacterial infection that has been called a “master of disguise.”

The man told doctors up front that he was in a monogamous 50-year-long marriage and had been sexually inactive in recent years following treatment for cancer. In a Clinical Problem-Solving report published today in the New England Journal of Medicine, doctors laid out the step-by-step tests and reasoning they used to get to the right diagnosis, which still didn’t answer all their questions.

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