Syphilis is now regarded by many as being of historical interest only in the aetiology of oral ulceration. Its manifestations are still often classified as the classical chancre, snail track ulcers and gumma. Recent literature suggests, however, that there has been a re-emergence of syphilitic ulcers and that these need not fall into the traditional categories. Atypical ulceration with no other apparent cause should prompt investigations for possible underlying infective causes, such as syphilis, because of the increased incidence of the disease.
It is important that clinicians maintain a high index of suspicion for syphilis when patients present with atypical oral lesions and syphilis serology should be part of the routine tests in this situation.