Intraoral Presentation of Secondary Syphilis: Case Report and Literature Review

Abstract

<h3>Introduction</h3> Syphilis is a well-documented disease caused by infection with the spirochete <i>Treponema pallidum</i>. Syphilitic infec- tion progresses through three distinct phases: primary, secondary, and tertiary. Each stage is defined by a unique set of clinical features. <h3>Materials and Methods</h3> A 50-year-old male patient was referred to the Columbia University Oral Pathology clinic for evaluation of painful oral lesions of several months duration. Prior to his presentation, the patient was seen by his primary care physician who ordered routine bloodwork and screening for sexually transmitted infections; all results were unremarkable. On intraoral examination, the patient had lesions involving the lower labial mucosa, right ventral tongue, and the right buccal mucosa. All lesions were similar in appearance: predominantly tan-white with an erythematous border and central ulceration. The lesions ranged from 0.6 to 1 cm in size and were slightly firm to palpation. A representative biopsy was performed of the right buccal mucosal lesion. <h3>Results</h3> On routine histologic examination the specimen consisted of soft tissue covered by benign-appearing stratified squa- mous epithelium with a dense superficial and perivascular plasma cell infiltrate within the connective tissue. Based on the inflammatory pattern and the patient's clinical presentation, there was an elevated suspicion for spirochete infection. <i>T. pallidum</i> stain was performed and highlighted spirochete microbes. <h3>Conclusions</h3> Based on the microscopic and clinical findings the patient was diagnosed with secondary syphilis. Though the features of syphilis have been well-studied, intraoral manifestations of the disease are rare. Typically, serologic testing is used for diagnosis, however these tests lack 100% sensitivity and specificity resulting in false negatives in a subset of patients. The accuracy of this testing is also known to decrease with repeat infection, as was later discovered to be the case in this patient. Therefore, biopsy and adequate suspicion for infection are necessary for diagnosis in some cases.