Key messages:
- Globally, the incidence of syphilis has increased over the last two decades.
- Oral manifestations may be the only or most significant feature of primary and secondary syphilis.
- Oral health clinicians should consider the possibility of syphilis diagnosis in cases of single isolated ulcers (i.e., chancre in primary syphilis) or in widespread oral ulceration or granulomatous disease (secondary syphilis).
- Oral health clinicians play an essential role in diagnosing and controlling syphilis infection, as the features of primary and secondary syphilis are self-limiting. Individuals who remain undiagnosed risk contributing to further spreading the disease and developing tertiary syphilis.
Introduction
Syphilis is a highly infectious disease caused by the anaerobic spirochete Treponema pallidum. The infection is most commonly transmitted through sexual contact, and, less commonly, through contact with infectious lesions. Vertical transmission can occur during pregnancy or birth. Syphilis is a public health reportable disease.
Syphilis can present with various mucocutaneous manifestations and nonspecific symptoms. The oral cavity is a site commonly affected in the early stages of syphilis infection. Identifying the diverse presentations seen across the different stages of syphilis infection can assist in early diagnosis and treatment.
This paper highlights the clinical features and management of six cases of oral syphilis. Five cases in the secondary stage of the infection and one case of primary infection with a single chancre. These cases demonstrate the nonspecific and variable clinical features of oral syphilis and highlight the importance of awareness in the oral health profession of these manifestations.
This paper also discusses the clinical characteristics of the primary, secondary, latent, and tertiary stages of syphilis infection, as well as testing, diagnosis, differential diagnosis, treatment, and complications of untreated syphilis.
Oral health clinicians have a vital role in recognizing the disease and referring for testing, early diagnosis, and treatment. Prompt treatment will reduce the incidence of devastating consequences of tertiary infections and the spread of the disease.
Conclusion
The prevalence of syphilis is increasing worldwide, despite public health efforts to eradicate the disease. Its variable presentations make diagnosing the disease challenging. Awareness of the range of oral features seen in syphilis infection may help oral health clinicians recognize the disease and arrange appropriate testing for early intervention. Enhanced screening, contact tracing, improved surveillance and education are also critical to limiting the spread of this disease.
