Oropharyngeal Condyloma Lata in Secondary Syphilis: Case Report and Literature Review

Samita Srisungsuk; Nichakarn Piyawannarat; Taweegrit Siripongboonsitti

doi:10.12659/AJCR.947118

16 April 2025 : Case report Thailand

Oropharyngeal Condyloma Lata in Secondary Syphilis: Case Report and Literature Review

Unusual clinical course, Challenging differential diagnosis, Rare coexistence of disease or pathology

Samita Srisungsuk^1BCDEF, Nichakarn Piyawannarat^1BCDEF, Taweegrit Siripongboonsitti^234ABCDEFG*

DOI: 10.12659/AJCR.947118

Am J Case Rep 2025; 26:e947118

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Table 1. Review of the literature on oral manifestations of syphilis compatible with condyloma lata features.

Case no.		Sex	Age (y)	HIV status	Documented OCL in publication	Risk/oral sexual practice	Symptom(s)	Duration	Provisional diagnosis	Location
1	Dai T, et al, 2019 []¹⁹	M	58	Neg	Y	Heterosexual with sex worker 4 m/ND	Foreign body sensation and sore throat	2 m	Lymphoma	Amygdaloid fossa
2	de Swaan B, et al, 1985 []⁸	M	28	ND	Y	ND/ND	Malaise, nausea, suffering from oral lesions	1 w	Warts	Hard palate and soft palate
3	Sharma P, et al, 2021 []²⁰	M	50	Neg	Y	Unprotected extramarital sexual intercourse 5 m/ND	Enlarged plaque on hard palate	1 m	ND	Hard palate
4	Kim JS et al, 2009 []¹⁴	F	20	ND	Y	ND/ND	Nodule lesions at umbilicus and mucous patch on lip	1 m	Condyloma acuminata	Lips
5	Lui Z et al, 2017 []²¹	M	24	Neg	Y	Homosexual, unprotected sexual intercourse 6 m/receptive oral sex	Growing of the oral lesion, foreign body sensation while swallowing	4 m	ND	Soft palate and hard palate
6	Carbone P et al, 2015 []¹³	M	29	Neg	ND	Homosexual/ Sexual encounter with new partner last 2 weeks/ND	Isolated nonpainful blister at palate	6 w	Oral candidiasis	Hard and soft palate
7	Ulmer A, Fierlbeck G, 2002 []²²	M	26	Neg	ND	ND/ND	Oral lesion with pain on swallowing/ previous history of penile chancre	ND	ND	Tongue, hard and soft palate, tonsils
8	Yamanaka A and Ga N, 2024 []²³	M	40	ND	ND	ND/ND	Sore throat	1 m	ND	Posterior oropharynx, upper uvula, tonsils
8	Kolios AG et al, 2010 []²⁴	M	40	ND	ND	Homosexual/ND	Sore throat with cervical adenitis	ND	ND	Pharynx, tonsils, uvula, soft palate
10	Farmkiss L et al, 2021 []²⁵	M	33	Yes	Y	ND/ND	White patch in the corner of mouth	5 w	Smoker’s keratosis or verrucous hyperplasia	Oral commissure
11	Bjekić M, and Ivanovski K, 2016 []²⁶	M	30	Neg	Y	Homosexual, single unprotected/receptive oral sex 3 m before onset	Painless verrucous lesion on his lower lip	3 w	ND	Lower lip
12	Zawar V et al, 2005 []²⁷	F	ND	ND	ND	Homosexual/ND	Sore progressive lesion in oral cavity	3 m	ND	Upper and lower lips
13	Cai W et al, 2020 []²⁸	F	50	Neg	ND	Sexual intercourse with a prostitute about 3 m prior	Painless oral lesion	1 m	ND	Hard palate
14	Hayder F et al, 2022 []²⁹	M	20	ND	ND	ND	Oral lesion	2 m	ND	Lip, tongue, hard palate
15	de Paiva SPG et al, 2018 []³⁰	F	32	Neg	ND	Absence of sexual intercourse for 3 years	Painful wounds in the mouth	5 m	ND	Tongue, frenulum
16	Mauceri R et al, 2023 []³¹	M	37	Yes	ND	ND	Multiple painful oral lesions, fever, malaise, difficulty eating	ND	Oral epithelial dysplasia or malignant disease	Buccal area, lip
17	Stepanova A, and Marsch WCh, 2006 []¹⁶	F	37	Neg	ND	Heterosexual, partner had latent syphilis/ND	Feeling of roughness and burning in mouth when chewing	4 m		Lips, buccal area, soft palate
18	Nam HM et al, 2010 []³²	M	19	ND	Yes	ND	Tongue lesion	ND	ND	Tongue
19	SATO A et al, 2001 []³³	F	26	Neg	ND	Recent multiple partners/ND	Food stick to the tongue, lingual pain	ND	ND	Palatal tonsil, palatoglossal arch, tongue, left angle of mouth
20	Jain A et al, 2021 []³⁴	M	19	Neg	ND	No/No	White lesion at lower lip	20 days	ND	Labia, hard palate
21	Ramirez-Amador V et al, 1996 []¹¹	M	32	Yes/CD4 354/mm	ND	Homosexual/ND	Oral lesion	4 m	Candidiasis	Soft palate, uvula, tonsillar area, and anterior pillars
22	Mani NJ, 1984 []¹⁸	F	19	ND	ND	Sexual contact 4 m/ND	Painful eruption on lower labial and buccal mucosa	1 w	ND	Lower labial and buccal mucosa
23	Mani NJ, 1984, []¹⁸	M	28	ND	ND	Sexual contact 3 m/ND	Painful eruption on lower labial mucosa	2 w	ND	Labial mucosa
24	Mari E, 2015 []³⁵	F	49	Neg	ND	ND	Infiltrate plaque at tongue	3 m	Oral candidiasis	Tongue
25	Seibt CE et al, 2016 []³⁶	M	45	Neg	ND	Married/ND	Multiple painful lesions in the mouth	ND	Lichen planus, Pemphigus vulgaris	Upper lip mucosa near the commissure
26	Seibt CE et al, 2016 []³⁶	M	46	Neg	ND	Single/ND	Multiple painful lesions in the mouth	ND	Aphthous ulcer	Ventral tongue, hard palate
27	Seibt CE et al, 2016 []³⁶	F	53	Neg	ND	Married/ND	Multiple painful lesions in the mouth	ND	Spinocellular carcinoma	Soft palate, involving tonsil pillars
29	Seibt CE et al, 2016 []³⁶	F	29	Neg	ND	Long term relationship/ND	Multiple painful lesions in the mouth	ND	Leukoplakia, lichen planus	Hard palate
29	Seibt CE et al, 2016 []³⁶	F	39	Neg	ND	Married/ND	Multiple painful lesions in the mouth	ND	Pseudo-membranous candidiasis, lichen planus, pemphigus vulgaris	Apex and edge of tongue
30	Compilato D et al, 2009 []³⁷	M	45	Neg	ND	Denying any previous at-risk sexual behavior	Leukoplakia-like plaque of right buccal area	1 m	Idiopathic leukoplakia	Buccal, labial, tongue
31	De Paulo LFB et al, 2015 []¹²	M	19	ND	ND	ND	Skin lesions	ND	ND	Hard palate, labial, tongue
32	De Paulo LFB et al, 2015 []¹²	F	40	ND	ND	ND	No	ND	ND	Labial
33	De Paulo LFB et al, 2015 []¹²	F	25	ND	ND	ND	Genital lesion	ND	ND	Buccal, tongue
34	De Paulo LFB et al, 2015 []¹²	M	32	ND	ND	ND	No	ND	ND	Buccal, labial
35	De Paulo LFB et al, 2015 []¹²	F	9	ND	ND	ND	Skin lesion	ND	ND	Tongue, labial
36	De Paulo LFB et al, 2015 []¹²	M	29	ND	ND	ND	Genital lesion	ND	ND	Buccal, tongue
37	De Paulo LFB, et al, 2015 []¹²	F	21	ND	ND	ND	Genital lesion	ND	ND	Hard palate, labial
38	Eyer-Silva WDA, et al, 2017 []³⁸	M	45	Y	ND	Unprotected oral and anogenital sexual contact 3 m/Yes	Burning mouth, dysgeusia, glossodynia	4 w	ND	Tongue, oral commissure
OCL – oral condyloma lata; AGCL – anogenital condyloma lata; M – Male; F – Female; HIV – human immunodeficiency virus; Y – yes; ND – none documented; m – month; w – week; TPPA – particle assay; TPHA – hemagglutination assay; VDRL – venereal disease research laboratory; RPR – rapid plasma regain; mU – million units; NR – non-reactive; ECLIA – electrochemiluminescence assay; TRUST – Toluidine Red Unheated Serum Test; FTA-Abs – fluorescent treponemal antibody absorption; R – reactive; NR – non-reactive. Serologic toluidine red unheated serum test (TRUST) titer of 1: 6.
Case no.		Clinical characteristics	Other organs involvement	Anogenital condyloma lata	VDRL	TPHA/TPPA (FTA-Abs)	Other treponemal test and/or pathology	Treatment	Outcome
1	Dai T, et al, 2019 []¹⁹	Hypertrophic, reddish-brown, flat-topped, moist plaque	None	No	1: 128	R	DNA tpp 47 from biopsy lesion positive	Benzathine penicillin G 2.4 mU weekly ×2 w	Complete recovery(2 w)/RPR-1: 8 (3 m) RPR-NR (6 m)
2	de Swaan B, et al, 1985 []⁸	Extensive grey-red, hypertrophic plaque	None	No	R	R (2+)	Kolmer 1: 128, from Dark-field microscope	Procaine, penicillin G 600,000 U IM 10 days	Complete recovery (<10 days)/Kolmer-1: 32 (15 days)
3	Sharma P, et al, 2021 []²⁰	Single broad flat well‐demarcated erythematous, whitish, non-tender, odorless plaque of size 3–4 cm	None	No	1: 32	R	ND	Benzathine penicillin G 2.4 mU ×1 dose	Complete recovery(7 days)
4	Kim JS et al, 2009 []¹⁴	Whitish mucous patches	Condyloma lata of umbilicus and perineum	Y	1: 32	R (R)	ND	Benzathine penicillin G 2.4 mU IM ×1 dose	Complete recovery (2 w)/VDRL-1: 8 (3 m)
5	Lui Z et al, 2017 []²¹	Well-demarcated, broad, lobulated, greyish‐white, verrucous plaques	None	No	1: 8	R	ND	Benzathine penicillin G 2.4 mU IM weekly ×3 w	Complete recovery (2 w)/VDRL-1: 1(3 m)
6	Carbone Pet al, 2015 []¹³	White patches on the palate dorsal tongue developing to nonulcerated verruciform, fleshy lesion with focal erythema	Papular rash on buttock	No	R	R	Inflammatory epithelial hyperplasia, perivascular and subepithelial lymphocytes and abundant plasma cells infiltrate Immunohisto-chemical stains positive	ND	ND
7	Ulmer A, Fierlbeck G, 2002 []²²	Pseudome-mbranous lesions and erosions	Generalized lympha-denopathy	No	ND	1: 81,920 (R)	ND	Benzathine penicillin G 2.4 mU IM ×1 dose	Complete recovery (2 w)
8	Yamanaka A and Ga N, 2024 []²³	Non-ulcerated white plaques were present in a butterfly shape	ND	ND	ND	ND	from tissue biopsy	ND	ND
8	Kolios AG et al, 2010 []²⁴	Whitish patches with erythematous borders	Bilateral cervical lympha-denopathy, papular syphilids	No	1: 64	1: 81920 (R)	Capita-IgM absorption index 1.76	Benzathine penicillin G 2.4 mU IM weekly ×2 w	VDRL-weakly reactive. TPPA-1: 2560, Capita-IgM absorption index 0.91
10	Farmkiss Let al, 2021 []²⁵	Irregular, isolated white plaque	None	No	ND	ND	Positive immunohistochemistry with epithelial hyperplasia, plasmacytic inflammation, neuritis	ND	ND
11	Bjekić M, and Ivanovski K, 2016 []²⁶	Well-defined, round flat-topped, white in color, nonulcerated hypertrophic painless papillomatous lesion	None	No	1: 128	R	ND	Benzathine penicillin G 2.4 mU IM ×1 dose	Complete recovery (2 w)/VDRL-1: 8 (3 m)
12	Zawar V et al, 2005 []²⁷	Exuberant, numerous white plaques.	Episodic knee and elbow pain	ND	ND	ND	ND	ND	ND
13	Cai W et al, 2020 []²⁸	Painless, well-demarcated, nontender, elevated, flat-topped verrucous plaque	None	No	ND	ND	TRUST 1: 64/treponemal antibody positive/papillary hyperplasia of squamous epithelium, lymphocytes, infiltration with vascular proliferation	Oral minocycline 100 mg twice daily for 15days.(penicillin allergy)	Complete recovery(2 w)/TRUST 1: 4 (6 m)
14	Hayder F et al, 2022 []²⁹	Vegetating ulcerations on the lips with angular mucositis associated with a leukokeratotic aspect on the jugal mucosa	Multiple subman-dibular lymphade-nopathies.	No	ND	ND	Treponemal serology test (1: 20,480)/extensive plasma cell infiltrate	Benzathine penicillin G 2.4 mU IM ×1 dose	ND
15	de Paiva SPG et al, 2018 []³⁰	Multiple ulcerated lesions, covered by whitish membranes and surrounded by a discrete erythematous halo	ND	ND	1: 32	ND	ND	Benzathine penicillin G 2.4 mU IM ×1 dose	Complete recovery
16	Mauceri R et al, 2023 []³¹	White and red plaques on the right and left buccal mucosa and painful lesions localized on upper and lower labial mucosa	None	No	1: 128	ND	ECLIA IgM, IgG positive/plasma cells infiltrate, neoangiogenesis foci. Warthin Starry stain demonstrated spirochetes		Complete recovery (4 w)
17	Stepanova A, and Marsch WCh, 2006 []¹⁶	Sharply demarcated, irregularly configured, flat, non-indurate plaque on erythematous edge and grey-white swollen surface	Generalized indolent lymphadenopathy	No	1: 32	>1: 130,000 (R)	Erosive epithelial change with neutrophil infiltrate, mixed lymphocyte and plasma cells infiltration	Benzathine penicillin G 2.4 mU IM weekly ×3 w	Complete recovery(2 w)/VDRL-NR (3 m) TPHA-1: 2,560
18	Nam HM et al, 2010 []³²	Multiple erythematous papules and plaques on the tongue	None	No	R		TPHA reactive/irregular epidermal hyperplasia and perivascular lymphocytes and plasma cells infiltration in dermis	ND	ND
19	SATO A et al, 2001 []³³	Marked swelling and redness of bilateral palatal tonsil along with opaline plaque over palatoglossal arch	Cervical, submandibular lymphadenopathy, alopecia, psoriasic exanthema on plantar	No	1: 128	>2560 (>1280)	ND	1000 mg/day of Amoxycillin then 2000 mg of erythromycin ×6 w	Jarisch-Herxheimer reaction after amoxicillinComplete recovery(4 w)/VDRL-1: 64 (3 w)
20	Jain A et al, 2021 []³⁴	White irregular plaques seen on the inner aspect of the lower lip, Hard palate had ulcerative lesion with serpiginous margin	ND	ND	1: 16	R		Benzathine penicillin G 2.4 mU IM	Complete recovery(1 m)/
21	Ramirez-Amador Vet al, 1996 []¹¹	Extensive, painless, smooth, white plaques and papules on an erythematous base with a serpentine and reddish outline	None	No	1: 64	ND	Mixed cellular infiltrate plasma cells predominate, perivascular lymphocytic infiltrate, and obliteration of the vessels. Warthin-Starry stain: numerous spirochetes	Benzathine penicillin G 2.4 mU IM weekly ×3 w	Complete recovery(1 w)/VDRL-1: 32(3 m) VDRL 1: 16 (6 mos)
22	Mani NJ, 1984 []¹⁸	Well-defined multiple raised lesions with smooth grayish-white surface, erythematous soft palate	ND	ND	ND	ND	Serologic confirmed	ND	Complete recovery (2 m)
23	Mani NJ, 1984, []¹⁸	Extensive well-defined, slightly raised, grayish-white lesion with smooth and shiny surface and inflamed periphery	ND	ND	ND	ND	Serologic confirmed	ND	Complete recovery (1 m)
24	Mari E, 2015 []³⁵	Circular tender and infiltrated whitish plaques on the tongue	None	No	1: 32	R	neutrophils and plasma cells in dermis	Benzathine penicillin G 1.2 mU IM 2 fl	Complete recovery (15 days)/
25	Seibt CE et al, 2016 []³⁶	Ulcer and mucous plaque	ND	ND	1: 1024	(R)	ND	Benzathin penicillin G 2.4 mU IM weekly ×3 w	Complete recovery (2 w)/VDRL1: 32 (1 m)/VDRL 1: 2 (2 m)
26	Seibt CE et al, 2016 []³⁶	Mucous plaque	ND	ND	1: 128	(R)	ND	Benzathine penicillin G 2.4 mU IM weekly ×3 w	Complete recovery (2 w)/VDRL1: 32 (1 m)/VDRL 1: 2 (3 m)
27	Seibt CE et al, 2016 []³⁶	Nodule and ulcer	ND	ND	1: 128	(R)	ND	Benzathine penicillin G 2.4 mU IM weekly ×3 w	Complete recovery (2 w)/VDRL1: 64 (1 m)/VDRL 1: 8 (3 m)
29	Seibt CE et al, 2016 []³⁶	Mucous plaque	ND	ND	1: 32	(R)	ND	Benzathine penicillin G 2.4 mU IM weekly ×3 w	Complete recovery (2 w)/VDRL1: 1 (1 m)
29	Seibt CE et al, 2016 []³⁶	Mucous plaque	ND	ND	1: 128	(R)	ND	Benzathine penicillin G 2.4 mU IM weekly x 3 w	Complete recovery (2 w)/VDRL1: 32 (1 m)/VDRL 1: 2 (3 m)
30	Compilato D et al, 2009 []³⁷	Well-delimited, raised, corrugate, non-homogeneous, and “leukoplakia-like” white plaque, developing to whitish oral mucous patches	Fever, pharyngitis, asthenia, dysphagia, malaise, maculopapular rash on trunk, palms and soles	ND	1: 128	1: 2560	Lymphocytes, plasma cells, and eosinophils infiltrate in lamina propria, acanthosis, papillomatosis, hyperkeratosis, and various microabscesses	IM erythromycin1 weeks	Slight improvement in 1 week then loss follow-up
31	De Paulo LFB et al, 2015 []¹²	Mucous patches	Skin rash	ND	1: 8	(R)	ND	Benzathine penicillin G 2.4 mU IM	ND
32	De Paulo LFB et al, 2015 []¹²	Mucous patches	ND	ND	1: 32	(R)	ND	Benzathine penicillin G 2.4 mU IM	ND
33	De Paulo LFB et al, 2015 []¹²	Mucous patches	Genital lesion	Y	NR	(R)	ND	Benzathine penicillin G 2.4 mU IM	ND
34	De Paulo LFB et al, 2015 []¹²	Mucous patches	ND	ND	1: 128	(R)	ND	Benzathine penicillin G 1.2 mU IM weekly×4 doses	ND
35	De Paulo LFB et al, 2015 []¹²	Mucous patches	Skin rash	ND	NR	(R)	ND	Benzathine penicillin G 2.4 mU IM	ND
36	De Paulo LFB et al, 2015 []¹²	Leukoplakia-like plaque	Genital lesion	Y	1: 64	(R)	ND	Benzathine penicillin G 2.4 mU IM	ND
37	De Paulo LFB, et al, 2015 []¹²	Leukoplakia-like plaque	Genital lesion	Y	1: 32	(R)	ND	Benzathine penicillin G 1.2 mU IM weekly×4 doses	ND
38	Eyer-Silva WDA, et al, 2017 []³⁸	Whitish, non-wipeable hyperkeratotic thickening, commissural papule	None	No	1: 128	(R)	ND	Benzathine penicillin G 2.4 mU IM weekly ×3 w	Within 1 w
OCL – oral condyloma lata; AGCL – anogenital condyloma lata; M – Male; F – Female; HIV – human immunodeficiency virus; Y – yes; ND – none documented; m – month; w – week; TPPA – particle assay; TPHA – hemagglutination assay; VDRL – venereal disease research laboratory; RPR – rapid plasma regain; mU – million units; NR – non-reactive; ECLIA – electrochemiluminescence assay; TRUST – Toluidine Red Unheated Serum Test; FTA-Abs – fluorescent treponemal antibody absorption; R – reactive; NR – non-reactive. Serologic toluidine red unheated serum test (TRUST) titer of 1: 6.

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Oropharyngeal Condyloma Lata in Secondary Syphilis: Case Report and Literature Review

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