A persistent sore throat

Takanori Yamaguchi, Kei Suzuki This man in his 30s had a sore throat for two months and was initially thought to have viral pharyngitis. He then developed fever and enlarged, painful cervical lymph nodes. On examination, white patches were visible on the soft palate (fig 1). Biopsy of these patches excluded malignancy. Results from serum Treponema pallidumhaemagglutination and rapidplasma reagin (RPR) testswere positive (RPR: 120units) and secondary syphilis was diagnosed. Antibody test results for HIV-1 and 2 were negative. The man had condomless sex and mutual oral sex with a sex worker three months before presentation. He had no other sexual partners and no history of sexually transmitted diseases.