Multifocal white plaques on the tongue: isolated oral manifestation of secondary syphilis

A 36-year-old black male with a history of smoking and alcohol consumption presented with painless lesions on the tongue that had persisted for 5 days. Upon intraoral examination, multiple well-demarcated, non-removable white plaques were observed on the ventral surface of the tongue (Fig. 1). Extraoral examination revealed no lymphadenopathy or skin lesions and the patient reported no systemic symptoms, such as fever, malaise, myalgia, or sore throat. When questioned, the patient reported engaging in unprotected oral sex approximately 7 weeks prior to presentation of the oral lesions. Considering the clinical presentation, serological testing for syphilis was conducted. Blood sample was initially screened for Treponema pallidum antibodies using the chemiluminescent microparticle immunoassay (CMIA) test and the test was positive (24.46 S/CO). The non-treponemal test, Venereal Disease Research Laboratory (VDRL), returned a titer of 1:512. Based on these findings, a diagnosis of secondary syphilis was confirmed. Serological testing for human immunodeficiency virus (HIV), gonorrhea and hepatitis B and C was also conducted, with all results being negative. The patient was referred for treatment with a dose of 2,400,000 IU of intramuscular benzathine penicillin G. After treatment, the patient is undergoing quarterly serological monitoring until completing 1 year. Currently, the patient is 9 months into follow-up and has not shown any new signs of syphilis or recurrence of oral lesions. Although isolated oral manifestations of secondary syphilis are rare, accounting for about 7% of cases, they can serve as critical indicators of systemic infections, highlighting the need for clinicians to consider syphilis in the differential diagnosis when encountering unexplained oral lesions [1]. Moreover, as syphilis has shown resurgence in many regions, increased awareness among healthcare professionals is essential for early detection and treatment, which also helps to reduce transmission rates [2].

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