Homosexuality is being recognized with increasing frequency in the United States, and the physician must be knowledgeable of the presentations of venereal infection in this population. A 23-year-old man who denied homosexuality presented with a rectal mass and diffuse adenopathy. Biopsy of the mass was interpreted as histiocytic lymphoma. Subsequent serology had positive results for syphilis. Further questioning revealed a history of anorectal intercourse, and special stains of the mass revealed spirochetes. Syphilis must be considered in any young patient presenting with a rectal mass, regardless of the biopsy histologic characteristics or sexual history.