A 25-year-old man with no major medical conditions presented with a 2-month history of two painless ulcerated lesions in the midline of the lower and upper lips (Panel A). The round ulcers measured 0.8 cm to 2.4 cm in diameter with clean, smooth bases and slightly elevated, indurated borders. The patient also reported a 1-week history of symmetrically distributed nonpruritic macules on his trunk and limbs. Testing for the human immunodeficiency virus was negative. The patient reported having had unprotected orogenital sex with his girlfriend about 2 weeks before the onset of the ulcers. The physical examination revealed nontender, bilateral submandibular lymphadenopathy. Rapid plasma reagin testing was positive with a titer of at least 1:32. In addition, a Treponema pallidum particle agglutination assay was strongly positive, and a fluorescent treponemal antibody absorption test was positive for both IgG and IgM antibodies. The patient's girlfriend also had positive results on serologic analyses for syphilis, and both were treated with intramuscular penicillin. The lesions completely resolved during a 4-week period (Panel B).
sources:
Sergio Vano-Galvan, M.D., Ph.D.
Ramon y Cajal Hospital, Madrid, Spain
Ramon y Cajal Hospital, Madrid, Spain
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