We discussed an interesting case of a middle aged female with high risk sexual behavior, active smoker with alcohol use disorder who presents with 3 weeks of globus sensation and odynophagia likely a presentation of acute pharyngitis.

Remember to always take a sexual history in an adult with acute pharyngitis. On physical exam, make sure to look for signs of muffled voice, drooling, stridor, tripod positioning, crepitus and trismus when evaluating an adult with acute pharyngitis. Patient received a biopsy of her tonsil that resulted in IHC stain positive for Treponema Pallidum; RPR 1:65; Syphilis EIA positive. Patient was diagnosed with tonsillar syphilis- likely a primary syphilis presentation.