A persistent sore throat

This man in his 30s had a sore throat for two months and was initially thought to have viral pharyngitis. He then developed fever and enlarged, painful cervical lymph nodes. On examination, white patches were visible on the soft palate (fig 1). Biopsy of these patches excluded malignancy. Results from serum Treponema pallidum haemagglutination and rapid plasma reagin (RPR) tests were positive (RPR: 120 units) and secondary syphilis was diagnosed. Antibody test results for HIV-1 and 2 were negative. The man had condomless sex and mutual oral sex with a sex worker three months before presentation. He had no other sexual partners and no history of sexually transmitted diseases.bmj;382/sep07_10/e074870/F1F1f1Fig 1Oral manifestations of secondary syphilis include ulcerative lesions, mucous patches on the tongue, nodules, and leukokeratotic lesions.1



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