Oral forms of secondary syphilis, an illustration of the pitfalls set by the great imitator.

Abstract Introduction Syphilis is reemerging in certain populations, such as men who have sex with men (MSM), in particular. Oral manifestations are not uncommon and can render diagnosis difficult, particularly if seen in isolation. Materials and methods We recovered clinical data for all patients diagnosed with secondary syphilis referred to the national reference center for syphilis in Paris, France, from January 2000 to July 2019. We selected patients presenting oral symptoms only, and analyzed their general characteristics, time-to-diagnosis and clinical presentations. Results Secondary syphilis was diagnosed in 206 patients, 38 of whom (18%) presented oral manifestations, which were isolated in 14 patients (37%). The main oral manifestations were subacute erosive or ulcerative lesions (55%), mucous patches on the tongue (53%), nodular (10%) and leukokeratotic lesions (5%). Mean time-to-diagnosis was 4.5 months, but was significantly longer for patients with isolated oral symptoms (8.8 vs. 1.8 months p = 0.02). Conclusion Oral presentations of secondary syphilis are frequent and challenging for diagnosis, even in patients with epidemiological risk factors. Clinicians confronted with subacute oral lesions in such patients should bear in mind the possibility of this contagious, curable and sometimes severe disease.