Oral lesions as the presenting manifestation of syphilis: A case series of an alarming trend in Kuwait

Syphilis is a sexually transmitted bacterial infection caused by the spirochete <i>Treponema pallidum</i>. The global disease burden has recently been affected by a rise in the incidence and prevalence of syphilis across different regions. The latest epidemiological data available on the incidence of syphilis in Kuwait dates back to the 20th century, with no additional available data published since. While the signs and symptoms of syphilis may vary depending on the stage of infection, the oral cavity is typically affected at the primary and/or secondary stages. The diagnosis of syphilis can be difficult without suspicion, as it is known to mimic other diseases. In this case series, we present cases where oral lesions were the first, and in the majority of cases, were the only presentation of secondary syphilis. Most patients were initially misdiagnosed, resulting in a delay in their management. Healthcare providers need to be aware of the various oral manifestations of syphilis, as it can be the first and only presenting sign of the disease. Identifying oral lesions is key in diagnosing syphilis and preventing further transmission and complications of the disease. Diagnosis is made through serologic testing or direct detection of <i>Treponema pallidum</i> in tissues. The stage at diagnosis, as well as neurologic involvement, determines the treatment.