Acquired oral syphilis: epidemiology, diagnostic pitfalls, and treatment strategies

Acquired oral syphilis (AOS) remains a neglected yet clinically significant manifestation of Treponema pallidum infection, frequently overlooked in routine diagnostic workflows. This review examines the epidemiology, pathogenesis, clinical features, diagnostic challenges, and management of AOS, highlighting its relevance in contemporary clinical practice. A diagnostic algorithm is proposed.

Narrative review.

AOS continues to be underdiagnosed due to its protean clinical presentations, histopathological overlap with other oral diseases, and omission from most diagnostic guidelines. Oral manifestations may occur at any stage of syphilis and are frequently misinterpreted. Accurate diagnosis typically requires the integration of serological, histological, and molecular findings. A disproportionate burden is observed among vulnerable populations, particularly men who have sex with men and forcibly displaced individuals.

Improved awareness of AOS among oral health professionals is essential. Incorporating oral manifestations into sexually transmitted infection control strategies may facilitate earlier diagnosis, appropriate treatment, and strengthened reporting systems.