Primary and Secondary Syphilis as Chancre of the Mouth with Rash.

A 25-year-old woman presented to our hospital with a vesicular lesion in her mouth. Four weeks previously, she had consulted another clinic where she had been diagnosed with herpes simplex, and was prescribed acyclovir for seven days. The vesicular lesion did not respond to treatment. The patient was febrile and developed a rash on her face two days before presenting to our hospital. She worked as a commercial sex worker in Shinjuku, Tokyo, where she performed oral sex on male clients. She presented with a chancre on the lower lip near the right corner of her mouth and a rash on her face (Picture 1). The patient was diagnosed with primary and secondary syphilis based on the Rapid Plasma Reagin (RPR) titer and the Treponema Pallidum Hemagglutination Test (TPHA) titer, which were 1:64 and 1:10,240, respectively (1). We prescribed amoxicillin and probenecid for 14 days. Seven days later, her vesicular lesion and rash disappeared (Picture 2). Six months later, her RPR titer was found to have decreased to 1:8 and follow-up was terminated.

Picture 1.

Picture 2.

The authors state that they have no Conflict of Interest (COI).