Secondary Syphilis Oral — MFDS Part 1 MCQ

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ModerateOral MedicineSecondary Syphilis OralMFDS Part 1

A 28-year-old patient presents with generalised lymphadenopathy and a non-pruritic maculopapular rash involving the palms and soles. Syphilis serology is positive. Which oral finding is most characteristic of this stage of infection?

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Correct answer: E — Grey-white mucous patches coalescing into serpiginous snail-track ulcers

The palmoplantar, non-pruritic rash and generalised lymphadenopathy identify secondary syphilis. Its characteristic oral lesions are painless grey-white mucous patches, which may coalesce into serpiginous “snail-track” ulcers. These early mucocutaneous lesions are infectious. A solitary indurated, painless chancre is typical of primary syphilis, although it may occur on the lip or elsewhere in the mouth. A destructive palatal gumma is a late manifestation of tertiary syphilis. Hutchinson's incisors and interstitial keratitis are stigmata of late congenital syphilis; keratitis is also an ocular rather than an oral finding. Therefore, option E is the single best answer.

Reference: UK Health Security Agency and NHS England. NHS Infectious diseases in pregnancy screening programme handbook, section 6: Syphilis. Updated 30 June 2026. https://www.gov.uk/government/publications/infectious-diseases-in-pregnancy-screening-programme-handbook/nhs-infectious-diseases-in-pregnancy-screening-programme-handbook