Syphilis: the renaissance of an old disease with oral implications

Abstract

Syphilis is caused by Treponema pallidum an anaerobic filamentous spirochete. In recent years, striking outbreaks have occurred in USA, Canada, Russia, China and some areas of Central and Eastern Europe. Main epidemiology changes reflect sex industry, sexual promiscuity, decreasing use of barrier protection (i.e. condoms) due to false sense of security that nowadays sexually transmitted diseases are curable and lack of pertinent knowledge. Considering that the initial presentation of syphilis may be the oral cavity, it is of great relevance to include this disease in the differential diagnosis of unusual oral ulcerations and white patches. Primary syphilis is a highly infectious disease in which inappropriate treatment may be apparently curative while the patient remains highly infectious. It is then of pivotal importance that clinicians maintain a high clinical index of suspicion. At the present time, clinical-pathologic correlation together with serologic studies remain essential in establishing the diagnosis of syphilis.

Fig. 1

Secondary syphilis: maculopapular skin lesions of the neck

Fig. 2

Secondary syphilis: maculopapular and scaly lesions of the plantar area

Fig. 3

Moth-eaten alopecia in secondary syphilis

Fig. 4

Macerated plaques (condylomata lata) of the toe webs

Fig. 5

Ulceronodular skin lesion of lue maligna

Fig. 6

Oral chancre in a promiscuous woman who had unprotected oral sex

Fig. 7

Secondary oral syphilis: mucous patches covered by grayish, white pseudomembranes of the lower vestibular mucosa

Fig. 8

Secondary oral syphilis with lesions on the soft palate. The patient also had pharyngitis and laryngitis

Fig. 9

Perioral fissuring (rhagades) in a 3 year-old patient with congenital syphilis

Fig. 10

Silver stain of syphilis showing the corkscrew-shaped treponemes (×40)

Fig. 11

Immunohistochemical method: the spirochetes are visible in the lower epithelial lamina (×40)

Fig. 12

Secondary oral syphilis. Plasma cell, along with lymphocytes and macrophages are visible as a band-like infiltrate in the lamina propria and with a perivascular distribution (EE, ×20)

Fig. 13

Secondary oral syphilis. A perineural and perivascular plasmacellular infiltrate is visible in the deep lamina propria (EE, ×40)