Oral Secondary Syphilis: A Diagnostic Case Report

Syphilis, caused by Treponema pallidum, is a systemic infectious disease capable of affecting multiple organs. Oral manifestations frequently serve as early indicators of infection, often providing crucial diagnostic clues that enable timely diagnosis and treatment. A 25-year-old female patient presented to the stomatology department with a one-month history of painful oral ulcers. Examination revealed erythematous region, ulceration and white striated lesion resembling lichen planus, localized to the upper lip, hard palate, right buccal mucosa, and tongue, without accompanying cutaneous or genital lesions. The patient reported being diagnosed with syphilis six months prior, along with her husband, and having undergone previous treatment. Diagnostic testing showed positive results for both Rapid Plasma Reagin (titer: 1:64) and Treponema pallidum particle agglutination assay. The patient received penicillin therapy (2.4 MIU weekly for three weeks), resulting in complete resolution of symptoms and a subsequent decrease in RPR titer to 1:8 at one-month follow-up. Her husband was advised to undergo evaluation and monitoring. Secondary syphilis presents significant diagnostic challenges due to its highly variable clinical manifestations, earning its reputation as "the great imitator." This case highlights the importance of maintaining clinical suspicion for syphilis when evaluating persistent or atypical oral lesions, particularly in patients with relevant epidemiological history. This report serves as an important reminder to oral health professionals of their critical role in the early detection of systemic conditions that manifest orally, underscoring the need for comprehensive patient assessment and interdisciplinary collaboration in disease management.