Clinical Paper
Oral Medicine
Oral syphilis—re-emergence of an old disease with oral manifestations

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Abstract

Three representative cases of oral primary syphilis are presented. We wish to highlight the resurgence of this disease, which has occurred recently in the western world, particularly in Europe and the United States of America. Since the initial presentation may be oral, it is important to include syphilis in the differential diagnosis of patients presenting to oral diagnostic clinics with atypical oral ulceration. Recent developments in the serological diagnostic tests and treatment are reviewed. Early diagnosis and treatment has significant implications, not only for the patient, but also for previous and future transmission to contacts. Early syphilis is a highly infectious disease in which the lesions heal spontaneously, despite inappropriate treatment which may appear curative, and yet the patient remains infectious. It is therefore important that clinicians maintain a high clinical index of suspicion and crucial that an accurate diagnosis be made at presentation.

Section snippets

Case 1

A 28-year-old male attended a dedicated HIV dental treatment clinic complaining of oral ulceration, which had been present for 6 weeks (Fig. 1). There was no previous history of oral ulceration. The ulcer was painless and peripherally indurated. He was known to be homosexual. The differential diagnosis presented in Table 3 was considered. With regard to geographic variation in the presentation of the diseases listed, the following investigations were performed: chest X-ray, complete blood

Case 2

A 36-year-old male presented himself to the Accident and Emergency Department of Dublin Dental Hospital. He was concerned about a large, but relatively painless, ulcerated area, which had been present for 3 weeks.

He was otherwise fit and well with no significant medical history. On examination, he had a 3 cm diameter ulcerated area extending from the right commissure into the lip and buccal mucosa. This had an irregular firm margin and the base was very vascular, bled readily and there was some

Case 3

A 24-year-old female with an indurated, painless, ulcer of 8 weeks standing. The lesion had been much larger and was in the spontaneous healing phase. The patient was identified by contact tracing, following the diagnosis of genital syphilis in a previous male heterosexual partner. She was otherwise asymptomatic. There was no lymphadenopathy and she was afebrile. Chest X-ray, microbiological, immunological and haematological testing were non-contributory. The lesion was not biopsied Her

Discussion

We have described three representative cases of primary oral syphilis, which presented to an Oral Medicine department with atypical oral ulceration. Since syphilis is a notifiable disease in some countries, national epidemiological data is relatively robust from these areas. This has shown a consistent, dramatic increase in the incidence of syphilis in the last few years in the western world, particularly in the MSM sub-group.

Transmission of acquired infectious syphilis is most commonly by

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