Oral Mucous Patch of Secondary Syphilis

A 35-year-old male presented with an asymptomatic white lesion in the oral cavity for 2 weeks. The patient had unprotected sexual intercourse with an unknown female partner 3 months ago. There was no history of genital lesions in the past. On examination, single large 3 × 3 cm² whitish mucosal patch was present over the lower lip with erythema of gums and bleeding points [Figure 1]. No other skin or genital lesions were noted in the patient. A venereal disease research laboratory test was positive with 1:32 dilution, and the Treponema pallidum haemagglutination assay test was positive. Other investigations such as human immunodeficiency virus, hepatitis C virus and hepatitis B surface antigen were non-reactive. Thus, a diagnosis of secondary syphilis was made. The oral lesion is a mucous patch seen in secondary syphilis. The patient was treated with a benzathine penicillin 2.4 million units as single intramuscular dose. At the 1-month follow-up, the lesion healed completely. A higher degree of suspicion is needed to diagnose such cases when the presentation is only an oral lesion without any other skin lesions. Syphilis is caused by T. pallidum with varied kind of clinical manifestations. They can present with cutaneous or mucosal lesions. The lesions in the oral cavity of secondary syphilis includes ulcers such as snail track, mucous patch and condyloma lata presenting as split papules at the angles of mouth.

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Figure 1:

Single large 3 × 3 cm whitish mucosal patch noted over the lower lip with erythema of the gum and bleeding spots.

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