Diagnosis of oral syphilis remains a challenge- a case repor
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A 45-year-old man presented at the department with a 3-month history of persistent oral ulcer with mild pain in his oral mucosa. He denied any skin and genital lesions or other accompanying symptoms. He was diagnosed as recurrent aphthous ulcer initially and was prescribed topical steroid with no improvement. He was referred to the ENT department where doctor took the biopsy. It was reported the non-specific inflammation pathologically, and he was given Cydiodine lozenge. The oral ulcer had not healed and he came for further consultation.

Physical examination revealed mucous patches with erosions located in his soft palate and the abdomen of the tongue, the patches are irregular, slightly elevated, well-defined and with a red halo around, covered with a white or gray pseudomembrane. No genital or skin lesions were noted. Since the diagnosis remained indefinite, further investigations were ordered.

Serological tests for rapid plasma reagin (RPR) [titre: 1:32] and treponema pallidum haemagglutination [TPHA] were positive, while the tests for HIV and hepatitis C were negative. Therefore, the definite diagnosis of oral secondary syphilis was established. The patient was treated with standard intramuscular benzathine benzylpenicillin at 2 400000 IU once a week and the lesion completely resolved over 3-week period.

The global re-emergence of syphilis calls for more attention to recognize the entity. As the great imitator, oral secondary syphilis is common to be misdiagnosed or underdiagnosed because of its extensive clinical presentations. Identifying and recognizing the clinical signs of syphilis is of great significance for healthcare professionals to initiate prompt and appropriate management.

Source: https://www.ijidonline.com/article/S1201-9712(20)30593-2/fulltext?rss=yes