Oral findings in secondary syphilis

Abstract

Background: Syphilis is a sexually transmitted disease caused by Treponema pallidum. However, there are of hematogenic and vertical transmission. All health care professionals must be aware of the manifestations of this condition, such as oral lesions.

Objectives: This study to analyze and compare four clinical cases of syphilis that were diagnosed based on lesions in the oral cavity with published literature.

Material and methods: Four patients with a confirmed sorologic and clinical diagnosis of syphilis were examined, confirmated from manifestation of oral lesions together with analysis of serological laboratory tests and histopathological analyses.

Results: Lesions were found in classic sites such as lips, tongue and skin. However, there were also lesions on the hard palate, and labial commissure, which correspond to less than 5% of the syphilis oral manifestations.

Conclusions: The practice of unprotected oral sex may result in infection and development of syphilis. The acknowledgment of the oral manifestations of syphilis in all its period of training for health professionals is of basic importance, the association of clinical features, histopathological findings and serological tests are required to complete the diagnosis and correct treatment.

Figure 1

Different patterns of clinical presentation of secondary syphilis. (A) Grayish white lesion on lateral border of right tongue. (B) Circular ulcer and well delimited in asymptomatic lower labial mucosa (C) Ulcerated lesion with fibrinous borders at the commissure of the lips. (D) Exuberant mucous plate present on the tongue (left) caused volume increase and remodeling on the superficial relief of the tongue.

Figure 2

Oral and cutaneous clinical aspect of secondary syphilis (A) Reddish macules present in the palms of the hands and brackets. (B) Erythematous lesion present on the hard palate. (C) Extensive mucosal plaque present with erythematous areas in region of labial commissure and oral mucosa. (D) Ulcerated lesion present in labial commissure.

Figure 3

Histopathological aspects of oral syphilis. (A) Histopathological examination revealed hyperplasia of the epithelium. (B) A dense and diffuse chronic inflammatory infiltrate, composed mainly by lymphocytes and plasma cells, in the lamina propria. (C) The inflammatory infiltrate extended to the deeper area of the lamina propria and showed a perivascular pattern.