A 35-year-old man presented with a 3-week history of asymptomatic ulcerated lesions in the tongue (Fig. 1). He developed erythematous papules in the trunk and legs at the same time. The patient had no other systemic symptoms and reported having had unprotected sexual intercourse. Testing for the human immunodeficiency virus was positive. VDRL testing was positive with a titer of at least 1:64. A tongue biopsy revealed an inflammatory infiltrate suggestive of secondary syphilis with positive immunohistochemistry for Treponema pallidum (Fig. 2). The patient was treated with intramuscular benzathine penicillin for two weeks. The lesions completely resolved during a 4-week period. Syphilis is well known for its diversity of clinical manifestations. For this reason oral syphilis needs to be considered and investigated in any patient who presents with a nonspecific oral ulceration. Concurrent HIV infection should be considered in any patient with a sexually transmitted disease.

Fig. 1.

Asymptomatic ulcerated lesions in the tongue.

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Fig. 2.

Positive immunohistochemistry for Treponema pallidum.

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