A 27-year-old woman presented to her general practitioner with a 2-month history of tongue lesions (Figure 1), generalized arthralgia, and adenomegaly. Her physician requested general tests and human immunodeficiency virus (HIV) serology, which were negative, and neck ultrasound, which revealed reactional cervical adenomegaly. She was referred to a dental surgeon and dermatologist for further physical examination, which showed exanthema (Figure 2). Secondary syphilis was hypothesized, and a venereal disease research laboratory (VDRL) test was requested (titer 1:256). She was then diagnosed with secondary syphilis flat condyloma.
Syphilis is a systemic, progressive infection caused by Treponema pallidum, involving temporary skin and mucous membrane lesions that spontaneously heal, falsely suggesting cure. Thus, many infected patients do not seek medical help and continue spreading the pathogen, mainly through sexual contact1,2, partially explaining the 12 million new syphilis infections yearly worldwide, with a tendency to increasing incidence2,3.
Most of the syphilis cases are usually detected among men who have sexual intercourse with men. Therefore, HIV coinfection is common1. Syphilis has four classic stages: primary, secondary, latent, and tertiary. The most common secondary stage manifestations are mucocutaneous lesions (including nonpruritic rash) and lymphadenopathy2,3. Oral lesions may appear in the primary stage but tend to arise in the secondary stage. Distinguishing oral cavity features include painless ulcers or irregular mucosal plaques primarily affecting the tongue, lips, and jugal mucosa. Oral lesions usually contain excessive T. pallidum and are highly infectious1,2.
Secondary syphilis may mimic several diseases, including cancer, rheumatic disorders, hanseniasis, seborrheic dermatitis, pityriasis rosea, and drug rashes, complicating clinical diagnosis1–3. Arthralgia and ocular impairment occur rarely. The treatment of choice is penicillin2–3.
The present article highlights unusual clinical aspects of an ancient but reemerging infectious disease and may assist physicians and dental surgeons to diagnose syphilis. Introducing early, adequate treatment will reduce its spread.