Multiple ulcers in primary syphilis with negative rapid plasma reagin and Venereal Disease Research Laboratory tests: an unusual presentation during the re-emergence of syphilis in Albania

Since 1995 infectious syphilis has re-emerged in Albania. As syphilis has become more common, more unusual presentations are being recognized. We present a case of an HIV-negative man with primary syphilis presenting with multiple penile ulcers and negative rapid plasma reagin and Venereal Disease Research Laboratory tests. The case illustrates the challenges of diagnosing early syphilis and the importance of not relying on non-treponemal tests.