What is a Gumma?

A gumma is a soft, tumor-like growth of the tissues (granuloma) that occurs in patients with syphilis infection. Gumma involving the genitalia are rare, occurring in the context of tertiary syphilis and represent a significant diagnostic challenge. These lesions generally manifest in the bones, skin or mucocutaneous tissues as an infiltrative mass. Spinal syphilitic gumma can occur in intramedullary, intradural-extramedullary, or extradural space, which have different appearance in the results of imaging.

Syphilis Infection

In fact, syphilis is a highly contagious sexually transmitted bacterial infection (STI) caused by a type of bacteria known as Treponema pallidum. Specifically, it spreads via unprotected sex with an infected person. Consequently, syphilis can have very serious complications when left untreated.

Moreover, it is a highly contagious disease that’s mostly spread through sexual activity, including oral and anal sex. Notably, the infected person often doesn’t know that they have the disease and, as a result, passes it on to their sexual partner.

Furthermore, syphilis is an ancient disease that has been increasing in prevalence in recent years. Indeed, worldwide, syphilis is a highly prevalent infection among men who have sex with men (MSM).

According to the most recent estimation of the WHO, among 25 reporting countries, 11 countries reported that 5% or more of MSM were diagnosed with active syphilis in 2019. Additionally, 7 countries reported that 10% or more of MSM were diagnosed with active syphilis.

Causes of Gumma

In particular, a gumma is caused by the bacteria that cause syphilis. It appears during late-stage tertiary syphilis. Typically, it most often contains a mass of dead and swollen fiber-like tissue. Moreover, it is most often seen in the liver. However, it can also occur in the:

Guidelines from the Centers for Disease Control and Prevention (CDC) recommend parenterally administered penicillin G for the treatment of all stages of syphilis.

Furthermore, the recommended treatment for patients with syphilis is intravenous injection of aqueous penicillin G at 18–24 million U/day for 10–14 days.

In addition, for patients allergic to penicillin, intravenous injection of Ceftriaxone (2 g/day) could be considered as an acceptable alternative.

Moreover, Prednisolone is routinely added to prevent cord edema or Jarisch-Herxheimer reactions before the start of penicillin. Consequently, after the systemic anti-syphilis treatment, the symptoms of syphilitic gumma usually disappear.