Ten-year institutional trends in syphilis: The first-contact role of otolaryngology and diagnostic pitfalls

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Background and objective Syphilis, often referred to as “The Great Imitator,” can resemble malignant tumors in the head and neck region. Otolaryngologists (ENT) specialists frequently serve as the first point of evaluation for oropharyngeal lesions; however, quantitative data on ENT diagnostic patterns, predictive factors, and temporal trends remain limited. This study aimed to identify clinical predictors of ENT diagnosis and assess diagnostic time patterns and annual trends. Methods We retrospectively analyzed 58 syphilis cases over an 11-year period (2014–2025) at a single academic center. Predictors of ENT diagnosis were identified using multivariable logistic regression with internal validation through bootstrap resampling (1000 iterations). Diagnostic time was evaluated using Cox proportional hazards regression, while annual trends and the impact of the COVID-19 pandemic were analyzed using Poisson regression and period-stratified analysis. Results Among the 58 cases, 23 (39.7%) were diagnosed in ENT. Multivariable analysis identified oropharyngeal symptoms (adjusted odd ratio [OR] 110.49, 95% confidence interval [CI] 7.30–1673.39, p = 0.0007) and cervical lymphadenopathy (adjusted OR 30.61, 95% CI 1.94–482.75, p = 0.0150) as independent predictors of ENT diagnosis. Bootstrap validation confirmed minimal overfitting (mean optimism 0.007; optimism-corrected AUC 0.900). No significant difference in diagnostic time was observed between ENT and other departments. The proportion of ENT diagnoses increased markedly from 17.9% (2014–2019) to 60.0% (2020–2025; p = 0.0013), representing a 3.4-fold rise after the onset of COVID-19. Conclusions Oropharyngeal symptoms and cervical lymphadenopathy are strong predictors of ENT diagnosis, and their combination constitutes a characteristic pattern of syphilis. ENT diagnoses have increased substantially in the post–COVID-19 era. Implementing a “bundle testing” strategy—simultaneous tumor workup and syphilis testing—is crucial to prevent diagnostic delays in tumor-mimicking cases.

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