A 16 year old female student, in good general condition, came to our Unit, claiming to have been raped two months prior to the interview. She had not reported the incident due to personal reasons. She consulted about lesions in her mouth of approximately two weeks' evolution, which caused difficulty in phonation and swallowing.
During the anamnesis, the patient showed insecurity and concealment in her answers.
Examination of the buccal mucosa revealed the typical opaline, slightly raised, greyish-white plaques of syphilitic secondarily and other white lesions surrounded by a red halo, some multiple and some solitary. In figure 1, the white plaques can be seen in both commissures and, in the lower labial mucosa, in the midline, three more plaques. The one closest to the sulcus, opaline white, well circumscribed. Another plaque, approximately 2 cm in diameter, shows a small central red area, and close to the semi-mucosa, another similar one can be observed.

In figure 2, similar plaques are found on the left edge of the tongue, near the tip and in the posterior area. On the right edge, in the middle and posterior part, two similar plaques, each 1.5 cm in diameter, can also be seen. Close to the tip of the tongue, on the edges and extended towards the ventral side, a rough surface can be seen in figure 3. It was clinically diagnosed as hairy leukoplakia (LV) and could not be removed by scraping. The patient gave authorisation for an HIV test, which was carried out the following day and the result of which was delivered in person approximately thirty days later. After a first reactive VDRL (128 dls), the fluorescent treponema antibody test (FTA-ABS), the treponema haematoagglutination test (TPHA), and a spirochete demonstration of the exudate from one of the oral lesions or "dark field test" were requested, with a positive result. A mucosal biopsy was performed with a presumptive diagnosis of hairy leukoplakia. Due to the high serology titres obtained, classical treatment for syphilis with benzathine penicillin injections was immediately instituted. The result of the LV biopsy was confirmed. The patient did not return to the clinic and did not withdraw the HIV result, which was reactive. We have tried to locate the young woman to inform her of her condition, monitor the effectiveness of the syphilis treatment, and establish a possible treatment and follow-up of her immunodeficiency.