Indian Journal of Sexually Transmitted Diseases and AIDS
LETTER TO EDITOR
Year
: 2021  |  Volume : 42  |  Issue : 2  |  Page : 178--180

Oral condyloma lata: A rare case report


Pritee Sharma, Ramesh Kumar Kushwaha, Asha Nyati, Alpana Mohta, Suresh Kumar Jain 
 Department of Dermatology, Venereology and Leprosy, GMC, Kota, Rajasthan, India

Correspondence Address:
Dr. Suresh Kumar Jain
Department of Dermatology, Venereology and Leprosy, GMC, Kota - 324 005, Rajasthan
India




How to cite this article:
Sharma P, Kushwaha RK, Nyati A, Mohta A, Jain SK. Oral condyloma lata: A rare case report.Indian J Sex Transm Dis 2021;42:178-180


How to cite this URL:
Sharma P, Kushwaha RK, Nyati A, Mohta A, Jain SK. Oral condyloma lata: A rare case report. Indian J Sex Transm Dis [serial online] 2021 [cited 2022 Jul 2 ];42:178-180
Available from: https://www.ijstd.org/text.asp?2021/42/2/178/322369


Full Text



Sir,

Syphilis usually begins with a distinct painless and indurated ulcer at the contact site: the primary chancre. After spontaneous healing of the primary lesion, the clinical symptoms of secondary syphilis occur which presents with generalized lesions on the skin and mucous membranes, primarily macules progressing to papules. Mucosal involvement of the oral cavity, genital tract, or both, is common in the form of condyloma lata, which are raised, fleshy, white to gray lesions. Condyloma lata often develops without treatment of the primary chancre. A 50-year-old Hindu male presented with asymptomatic enlarging plaque since 1 month on hard palate. The patient had a 1 cm large asymptomatic lesion over hard palate. On inquiry, the patient said that initially the lesion was small grained sized which slowly increased to become coin sized over the next 1 month. There was a history of unprotected extramarital sexual intercourse 5 months back. There was no history of skin lesions and genital lesion.

On physical examination, there was the presence of a single broad flat well-demarcated erythematous whitish nontender, odor less plaque of size 3–4 cm on hard palate [Figure 1]. There were no other oral and cutaneous lesions. On lab investigations, VDRL test was positive with titre 1:32. Treponema pallidum hemagglutination test was also positive. Serologic test for HIV was negative. There was no other systemic involvement. Laboratory investigations were within normal range.{Figure 1}

On the basis of clinical and laboratory finding, the case was diagnosed as secondary syphilis with oral condyloma lata. The patient was treated with intramuscular benzathine penicillin G, 2.4 million units. The lesions disappeared within 1 week of treatment [Figure 2].{Figure 2}

Syphilis has a worldwide health problem with potential to manifest multiple patterns of skin and visceral diseases. Secondary syphilis occurs in up to 25% untreated patients manifest with systemic symptoms including malaise, fatigue, fever, and headache and a classical copper-colored maculopapular rash diffusely involving the trunk and extremities including the palms and soles, oral mucosal lesions; alopecia; and condylomata lata.[1],[2] It can be treated easily if recognized early. Condyloma lata is one of the characteristic mucosal signs of secondary syphilis. Lesions in the oral cavity have been rarely reported.[3] Typically, they are gray or white, moist, verrucous papules or plaques commonly located in the anogenital area. Atypical sites include warm, moist or intertriginous, such as the umbilicus, axilla, inframammary folds and toe web spaces. Eventhough, in oral cavity nonpathogenic treponema are also present, they hardly have any clinical significance. Differential diagnoses include condyloma accuminata, verruca vulgaris, oral lichen planus, oral leukoplakia, Bowen's disease, squamous cell carcinoma, and oral candidiasis. The most specific test for the diagnosis of T. pallidum includes dark groud illumination microscopy. Although, serologic testing remains the mainstay, since T. pallidum cannot be cultured. The traditional algorithm uses a nontreponemal serologic test for screening followed by a specific treponemal antigen serologic test for confirmation.[4] Even though, the spectrum of syphilis depends on stage of patient's presentation, occurrence of purely oral lesions has been a rarely reported entity in literature. An awareness among at risk patients is the most effective way to prevent transmission, progression, and provide a prompt treatment.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form, the patient has given his consent for his images and other clinical information to be reported in the journal. The patient understands that name and initials will not be published and due efforts will be made to conceal identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

References

1Abell E, Marks R, Jones EW. Secondary syphilis: A clinico-pathological review. Br J Dermatol 1975;93:53-61.
2Singh AE, Romanowski B. Syphilis: Review with emphasis on clinical, epidemiologic, and some biologic features. Clin Microbiol Rev 1999;12:187-209.
3de Swaan B, Tjiam KH, Vuzevski VD, Van Joost T, Stolz E. Solitary oral condylomata lata in a patient with secondary syphilis. Sex Transm Dis 1985;12:238-40.
4Cates W Jr., Rothenberg RB, Blount JH. Syphilis control. The historic context and epidemiologic basis for interrupting sexual transmission of Treponema pallidum. Sex Transm Dis 1996;23:68-75.