Dynamic morphological changes in oropharyngeal secondary syphilis documented over 56 days

Secondary syphilis is known for its diverse mucocutaneous manifestations; however, detailed chronological documentation of oropharyngeal lesions is extremely limited. We report the case of a man in his 20 s who presented with mucous patches that were initially suspected to represent an oropharyngeal tumor. Although syphilis was clinically suspected at the initial visit, the patient declined serological testing and was advised to refrain from sexual activity. Serial endoscopic observations over 56 days demonstrated dynamic morphological changes, including spontaneous regression, subsequent exacerbation, and near-complete resolution without treatment. Secondary syphilis was subsequently confirmed by serological testing. The prolonged untreated period resulted from the patient's refusal to undergo testing rather than a failure to recognize the disease. To our knowledge, this is the first report to document and illustrate the chronological morphological evolution of oropharyngeal lesions in a single patient with secondary syphilis through sequential endoscopic examinations. This case highlights that transient improvement does not exclude active disease and underscores the importance of considering syphilis in the differential diagnosis of fluctuating oropharyngeal lesions.