A 10-year retrospective study analyzed 307 syphilis cases diagnosed between 2013 and 2023, revealing that 25.8% of patients presented with atypical manifestations. These included annular lesions, psoriasiform eruptions, and other unusual skin findings, particularly in secondary syphilis. Atypical presentations were associated with homosexual orientation, syphilis reinfection, and VDRL titers > 1:32. The study highlights the wide range of syphilis manifestations, which can pose diagnostic challenges and delay treatment. Atypical cases were more common in secondary syphilis and included features like Follmann balanitis, extragenital chancres, and neurosyphilis with atypical symptoms. The study also found that atypical presentations were not linked to HIV infection or other STIs. The findings emphasize the importance of recognizing atypical syphilis manifestations for accurate diagnosis and timely treatment.A 10-year retrospective study analyzed 307 syphilis cases diagnosed between 2013 and 2023, revealing that 25.8% of patients presented with atypical manifestations. These included annular lesions, psoriasiform eruptions, and other unusual skin findings, particularly in secondary syphilis. Atypical presentations were associated with homosexual orientation, syphilis reinfection, and VDRL titers > 1:32. The study highlights the wide range of syphilis manifestations, which can pose diagnostic challenges and delay treatment. Atypical cases were more common in secondary syphilis and included features like Follmann balanitis, extragenital chancres, and neurosyphilis with atypical symptoms. The study also found that atypical presentations were not linked to HIV infection or other STIs. The findings emphasize the importance of recognizing atypical syphilis manifestations for accurate diagnosis and timely treatment.