Oral Syphilis Research Articles

ACQUIRED ORAL SYPHILIS: REPORT OF 2 CASES AND REVIEW OF THE LITERATURE

Acquired oral syphilis (AOS) is an infectious disease caused by the bacterium Treponema pallidum. Transmission occurs mainly by sexual contact with infectious lesions. Two cases of AOS have been reported. A 29-year-old male patient presented with grayish-white mucous patches and reddish ulcers in the lips, lateral border of the tongue, floor of the mouth, and the oropharynx. The patient was a marijuana user. A 33-year-old female patient presented with pruritus of the tongue and throat, pain in the upper labial mucosa for 1month, and halitosis. Reddish ulcers 5 mm in size were detected in the upper labial mucosa, posterior dorsal surface of the tongue, gingiva, and palate. A maculopapular cutaneous rash was also observed. The patients did not report systemic comorbidities. Venereal Disease Research Laboratory (VDRL) and fluorescent treponemal antibody absorption (FTA-ABS) were both positive, confirming the clinical diagnosis of syphilis. They patients were referred for adequate treatment and remission of the oral lesions was observed. Support: FAPEMIG.

ORAL SYPHILIS: A REPORT OF TWO CASES AND A LITERATURE REVIEW OF THIS RE-EMERGING ENTITY

Objective Syphilis is a sexually transmitted, infectious disease caused by Treponema pallidum. It can manifest clinically in three stages: primary, secondary, and tertiary. While rare, oral syphilis cases are starting to re-emerge. Our objective is to report 2 additional cases of oral syphilis—one case of primary syphilis and 1 case of secondary syphilis—to highlight the need to consider this entity in the histopathologic differential diagnosis of nonspecific mucositis. Findings Both cases presented to outside oral surgeons in separate geographic regions. In case 1, a 25-year-old male presented with a six-week history of a 1.0 cm non-healing ulcer of the right lateral tongue. In case 2, a 28- year-old male presented with welt-like, slightly raised, red/white lesions of the lateral tongue, buccal mucosa, and hard and soft palates. The clinician reported no other lesions on the body and a negative STD test. An excisional biopsy was performed for case 1 and an incisional biopsy for case 2. Histopathologically, case 1 showed an ulcer with an underlying lichenoid lymphoplasmacytic infiltrate with perivascular plasma cells. Case 2 showed epithelial spongiosis and prominent neutrophilic microabscesses with an underlying lichenoid lymphoplasmacytic infiltrate. Perivascular and perineural plasma cells were also present. Because of the perivascular plasma cells in both cases, Treponema immunohistochemistry was ordered, and it highlighted many spirochetal organisms in the epithelium and superficial lamina propria in both cases. Given their respective clinical presentations, case 1 was diagnosed as a chancre of primary syphilis, while case 2 was diagnosed as a mucous patch of secondary syphilis. Conclusion Due to the resurgence of oral syphilis cases, clinicians should be aware of the histopathologic features and order the appropriate ancillary studies in suspected cases. Proper histopathologic diagnosis is important to prevent the spread and further re-emergence of this treatable infection and avoid misdiagnosis as nonspecific mucositis.

Diagnosing acquired syphilis through oral lesions: the 12 year experience of an Oral Medicine Center

IntroductionA resurgence of syphilis in Brazil has been reported in recent years. ObjectiveWith this in mind, the present study sought to investigate the frequency, demographics, and clinical characteristics of patients with acquired syphilis with oral involvement who received medical care at an Oral Medicine Reference Center in a Brazilian Public Hospital. MethodsA retrospective study, spanning a period of 12 years, was performed to identify changing trends in syphilis over time. Medical records from all patients diagnosed with acquired syphilis who received medical care at the Hospital's Oral Medicine Clinic from 2005 to 2016 were reviewed, and the demographic and clinical data were collected. ResultsA total of 85 patients had been diagnosed with acquired syphilis, with a significant increase in the number of cases over the past 5 years. Patients ranged from 16 to 76 years of age, with a peak in the third and fourth decades. Forty-eight cases affected males (56.5%), while 37 cases affected females (43.5%). Most of the oral lesions appeared as unique ulcers or plaques, with the lips and tongue representing the most affected sites. All cases were positive for Venereal Disease Research Laboratory or Fluorescent Treponemal Antibody Absorption, and treatment was performed with Penicillin G benzathine in most cases (84.7%). ConclusionThe frequency of oral syphilis has been rising over time and oral lesions may well represent a diagnostic clue; therefore, oral health professionals must be made aware and properly trained in an attempt to develop a high degree of clinical suspicion in the diagnosis of syphilis.

Secondary Oral Syphilis: literary review and case reports

Secondary Oral Syphilis: literary review and case reports

Forty cases of acquired oral syphilis and a review of the literature

The aim of this study was to describe 40 cases of acquired oral syphilis (AOS) and to discuss the distribution of demographic characteristics, clinical features, and differential diagnosis of the disease. A retrospective study was conducted covering a 17-year period at a single institution in southern Brazil. Moreover, a literature review was performed through a search of the PubMed database for articles on AOS published between 1955 and March 2018. Data were analyzed descriptively. The predominant group within the case series was male patients in their twenties. The vast majority of cases (92.5%) were in the secondary stage of the disease. The lips were the most commonly affected site, with greyish-white mucous patches and reddish ulcers. In the literature review, the largest number of reported cases came from North America. Male patients in the third and fourth decades of life were most affected. AOS occurred more commonly as mucous patches and ulcers on the tongue and palate. Similarities regarding the distribution by sex, age, and anatomical location were found in the present study when compared to cases reported elsewhere. Clinicians, oral pathologists, and maxillofacial surgeons should familiarize themselves with the variable spectrum of signs and symptoms of AOS in their clinical practice to improve diagnosis and management.

Middle-aged man with symmetrical lesions in his throat

A 51-year-old man infected with HIV for more than 10 years visited our HIV clinic due to lesions in his throat. He had a CD4 T-cell count of >500 cells per μl and a HIV-RNA viral load of <20 copies per mm3. Nearly 3 months before this presentation, the patient participated in oral sex. At the clinic, he presented with a milky and (Fig. 1A ). He did not have any other symptoms on his skin. What is the diagnosis? Answer: Butterfly sign of pharyngeal syphilis. The patient had a history of syphilis 4 years prior to this visit. Although he was treated with amoxicillin 4 years prior, his serological tests for syphilis (STS) titer had remained positive at a low level. Laboratory testing revealed that his rapid plasma reagin (RPR) test result increased from 1:4 to 1:512 (normal value, <1), and his Treponema pallidum hemagglutination (TPHA) level had increased from 1280 to >40,960 (normal value, <1). Co-infections of HIV and syphilis are common [[1]Imahashi M. Izumi T. Watanabe D. Imamura J. Matsuoka K. Ode H. et al.Lack of association between intact/deletion polymorphisms of the APOBEC3B gene and HIV-1 risk.PLoS One. 2014; 9e92861Crossref PubMed Scopus (22) Google Scholar]. Notably, HIV patients often demonstrate prolonged STS positivity even after appropriate treatment. Thus, it is hazardous to diagnose syphilis solely based on a serological test. Pharyngeal syphilis accounts for 7% of syphilis cases [[2]Nishijima T. Teruya K. Shibata S. Yanagawa Y. Kobayashi T. Mizushima D. et al.Incidence and risk factors for incident syphilis among HIV-1-infected men who have sex with men in a large urban HIV Clinic in Tokyo, 2008–2015.PLoS One. 2016; 11e0168642Crossref PubMed Scopus (17) Google Scholar]. Due to the diversification of patients' sexual behaviors, healthcare providers should be aware of the oral manifestation of syphilis [[3]Dybeck Udd S. Lund B. Oral syphilis: a reemerging infection prompting Clinicians' alertness.Case Rep Dent. 2016; 20166295920PubMed Google Scholar]. The patient was treated with amoxicillin for a month, and the symptoms of pharyngeal lesions resolved rapidly. The picture shows the patient's soft palate after 2 months of follow-up (Fig. 1B). The authors disclose no financial or proprietary conflicts of interest with this publication. Consent was obtained and no patient identifiers are evident on the clinical image.

Use of Oral Fluid in a Rapid Syphilis Test Assay

Background From 2014 to 2015, the syphilis rate in the United States increased by 19%, reaching its highest rate since 1994. Currently, point-of-care syphilis assays use fingerstick or venipuncture whole blood to identify Treponema pallidum (TP) antibodies by qualitative immunoassay. However, patients and providers prefer oral fluid testing to whole blood testing. In this study, we aimed to determine whether a rapid syphilis test intended for use on whole blood could be used to detect TP antibodies in oral fluid.Methods Oral fluid was collected from 72 participants using the Super•SAL™ Oral Fluid Collection Device (Oasis Diagnostics®, Vancouver, WA). The device uses an absorbent cylindrical pad to collect and filter ~1 mlml of oral fluid. Oral fluid filtrate was tested using the SD Bioline Syphilis 3.0 rapid test (Alere Diagnostics, MA) following manufacturer directions for whole blood. TP particle agglutination (TPPA) and rapid plasma reagin (RPR) results derived from participants’ medical records were used as reference values. We used three different definitions as comparators: 1: TPPA reactive; 2: TPPA and RPR reactive and 3: TPPA reactive and RPR titer >1:4. Those with non-reactive TPPA and RPR results were considered seronegative. We calculated the sensitivity and specificity for definition 1 and sensitivity for definitions 2 and 3. We used the exact binomial method to determine 95% confidence intervals (CI).ResultsWith definitions 1, 2, and 3, respectively, sensitivity was 83.3% (CI: 67.2, 93.6), 86.4% (CI: 65.1, 97.1), and 100% (CI: 71.5, 100). Specificity was 47.2% (CI: 36.5, 75.5).Conclusion The high sensitivity of the SD Bioline Syphilis 3.0 test using oral fluid suggests a strong potential for the development of accurate rapid oral syphilis tests. Sensitivity increased with higher RPR titer. False positive results may be due to the presence of non-venereal treponemal antibodies in oral fluid. Further research and development are needed to optimize specificity.Disclosures All authors: No reported disclosures.

Persistent oral ulceration and enlarged necrotic lymph nodes: a clinicopathological conference

AbstractSyphilis is an infectious disease caused by the anaerobic spirochaete Treponema pallidum. Syphilis is known to present with oral manifestations, namely transient ulcers in its primary form, snail‐track ulcers in the secondary form and gumma formation in its tertiary form. The patient was presented to the oral and maxillofacial clinic with persistent oral ulceration in the left buccal mucosa, with rolled margins and rapid onset cervical lymphadenopathy therefore mimicking the appearance of oral squamous cell carcinoma. Biopsies of the oral ulceration and of the lymph nodes revealed no malignancy, but features consistent with an infectious process. This case report highlights the diagnostic challenges with the diagnosis of oral syphilis. It also discusses the laboratory tests used to finalise a diagnosis of syphilis, and aims to raise awareness of potential differential diagnosis.

Oral syphilis seen at the lateral surface of the tongue: a case report with literature review

Oral syphilis seen at the lateral surface of the tongue: a case report with literature review

Oral Syphilis: A Reemerging Infection Prompting Clinicians' Alertness.

Syphilis is a rare but increasing disease. Due to changing sexual habits, presentation of oral manifestations may rise. Since syphilis may mimic other oral manifestations, diagnoses can be difficult. Clinicians need to be aware that ambiguous oral manifestations may in fact be caused by oral syphilis. Here, we present a case of extended diagnostic delay highlighting the importance of consulting an expert in infectious diseases in case of obscure oral lesions not responding to standard treatment. Despite seven visits to six different medical doctors, a patient who presented with oral syphilis was continuously misdiagnosed. After 6 months of increasing complaints and deteriorating severity of disease, the patient was referred to an oral and maxillofacial surgeon where the correct diagnosis was determined and proper treatment initiated.

Ethnobotany: A Living Science for Alleviating Human Suffering

Ethnobotany: A Living Science for Alleviating Human Suffering

Clinicopathologic features, microvessel density, and immunohistochemical expression of ICAM-1 and VEGF in 15 cases of secondary syphilis with oral manifestations

Several studies have reported the clinical aspects of oral syphilis, but few papers have considered the involved immunoinflammatory mechanisms. To analyze the clinicopathologic features and expression of immunoinflammatory and vascular proteins in oral secondary syphilis. Fifteen patients with oral secondary syphilis were included; histologic features were analyzed using hematoxylin-eosin-stained histologic slides and immunohistochemical reactions were performed against intercellular adhesion molecule 1 (ICAM-1), vascular endothelial growth factor (VEGF), and CD34. Lesions presented as multiple plaques and ulcers mostly located on the tongue, lips, and palate. They were covered by a stratified epithelium of irregular thickness showing exocytosis associated with a subjacent plasma cell infiltrate arranged in perivascular and perineural patterns. ICAM-1 and VEGF were expressed on endothelial cells and leukocytes, and microvessel density was similar on the superficial and deep regions of the connective tissue. Expression of immunoinflammatory and vascular proteins was intense, suggesting their participation on the pathogenesis of oral secondary syphilis.

Ethnomedicinal Plants Used by Traditional Healers to Treat Oral Health Problems in Cameroon.

Objectives. The objective of the study was to determine the therapeutic methods used by traditional healers to treat oral diseases in Cameroon. Methods. A total of 200 traditional healers with a mean age of 50.4 ± 14.2 years from all the provinces of Cameroon were studied using questionnaires. Information elicited was the local names of the medicinal plants used for the management of oral problems, their routes of administration, and methods of usage. Identification of live or dried plants or photographs of sample of the plants was done by a taxonomist. Results. The majority of the participants were males urban dwellers aged 41–50 years, 112 (56.0%) practice as herbalists and 56 (28.0%) were trained on medications preservation, 77(56.6%) treat diseases inside or outside the mouth, and 9.0% reported being specialist in oral diseases treatment. Of the 52 plants identified, 48 are used in the management of toothache, sore throat, mouth sores, abscess, broken tooth and jaw, tooth sensitivity, mouth thrush, dental caries, gingivitis, sinusitis, tonsillitis, xerostomia, oral syphilis, oral cancer, TMJ pain, halitosis, and tooth bleaching and 4 plants are used for dental extraction. Roots, leaves, and bark were the parts of plants used and some minerals as adjuncts. Conclusion. The study provides comprehensive information on therapeutic methods employed by traditional healers for the treatment of oral diseases.

Dermatological manifestations common in hospitalized HIV patients

Results Out of total of 134 HIV-positive patients, 41 patients had cutaneous manifestations, 28 were male (68.29%) and 13 female (31.70%). Most patients were in the age group 16-30 years (58.53%). The majority of patients belonged to the urban area (65.85%) and had a low educational and socioeconomic status (only 56.09% patients graduated secondary school; 82.92% of the patients were unemployed). The prevailing route of transmission was parenteral (41.46%), most patients had stage C3 HIV disease (56.09%), and only 24.39% of patients had undetectable viral load. Most patients were undergoing ARV regimen (80.48%), 12.19% were naive and 7.31% had ceased therapy. 17 patients had 2 concomitant dermatological manifestations (41.46%), while 13 were treated for only one skin disease (31.70%); 19.51% patients were diagnosed with 3 concurrent dermatological diseases and 7.31% with 4 simultaneous skin disorders. The most common HIV-related dermatological manifestations were oral candidiasis (78.04%), seborrheic dermatitis (14.63%), lipodystrophy (12.19%), tinea corporis (7.31%), herpes zoster (4.87%), syphilis (4.87%) and cellulitis (4.87%). CD4 counts ranged between 2-1551 cells/μL, with a mean CD4 of 139 cells/μL. Oral candidiasis was correlated with a mean CD4 count of 305 cells/μL, seborrheic dermatitis was related to a mean CD4 of 233 cells/μL, while lipodystrophy was associated with a mean CD4 of 202 cells/μL.

A Case of Secondary Oral Syphilis Presenting with Milk Patches in the Buccal Mucosa

We report a case of secondary oral syphilis presenting with milk patches in the buccal mucosa. A 43-year-old man presented in our hospital because of gingival pain from brushing his teeth. In the bilateral buccal mucosa he had milk patches surrounded by painless erythema with a clear borderline. Multiple submandibular lymph node swellings were palpable, but general eruptions were absent. On serological examination, the RPR test result was x64 and the TPHA result was > 40,960, so a diagnosis of secondary oral syphilis was made. Oral lesions disappeared after the administration of AMPC 750 mg/day for three weeks.

Syphilis related to atypical oral lesions affecting an elderly man. a case report

To present a case of oral syphilis in an old patient. Syphilis seems to be resurging mainly in the young. However, in the last twenty years, the elderly have become more susceptive to infectious diseases due to a more frequent use of sildenafil. An 83-year-old man was referred to our clinic complaining of burning mouth. His medical history revealed papular lesions on chest and penis glans, which had been diagnosed and treated as scabiosis 2 months prior to our assessment. The intra-oral examination showed erosive and patch lesions on the bilateral lip commissures, the palate and the border of the tongue. Initially, oral herpes was suspected. However, both the serological test and the cytology were negative. Therefore, syphilis was hypothesised. Non-treponemic (VDRL) and treponemic tests (FTA-ABS) were reagent and secondary syphilis was confirmed. The treatment consisted of penicillin G benzathine 2.4 million IU/IM for 4 weeks. Both oral and skin lesions had complete remission. The present case illustrates that syphilis should be suspected in old patients with oral atypical lesions.

Oral Syphilis: a retrospective analysis of 12 cases and a review of the literature

To present a retrospective analysis of multicentre case series of oral syphilis and a review of relevant literature. A PUBMED search was carried out from 1950 to 2011. Clinical records of patients with exclusive/prevalent oral manifestations of syphilis were collected and examined in three independent hospitals. Of 23 reports describing 34 patients were detected through the review (35% primary, 56% secondary, and 9% tertiary disease), describing unspecific ulcers (59%), mucosal patches (23%), keratosis (6%), pseudomembranes (3%), and gumma (9%). Multicentre case series revealed 12 patients with oral syphilis, of which 17%, 58%, and 25% with, respectively, primary, secondary, and tertiary lesions. Clinically, patients showed white patches (17%), blistering mucositis (8%), chronic unspecific ulcers with/without skin lesions (50%), gumma (17%), and necrosis of the dorsum of the tongue (8%). Oral bullae and tongue necrosis are never described in the current review. Diagnosis of syphilis remains a challenge because of the multiform and polymorphous clinical pattern at onset and its ability to imitate different diseases. It is mandatory to include syphilis in the differential diagnosis of unusual oral lesions. Diagnosis of oral lesions of syphilis is often difficult, and biopsy is required in controversial cases.

Clinical Spectrum of Oral Secondary Syphilis in HIV-Infected Patients.

Background. Oral lesions may constitute the first clinical manifestation in secondary syphilis, but detailed descriptions in HIV-infected individuals are scarce. Objective. To describe the clinical characteristics of oral secondary syphilis in HIV-infected patients and its relevance in the early diagnosis of syphilis. Methods. Twenty HIV/AIDS adult subjects with oral secondary syphilis lesions presenting at two HIV/AIDS referral centers in Mexico City (2003–2011) are described. An oral examination was performed by specialists in oral pathology and medicine; when possible, a punch biopsy was done, and Warthin-Starry stain and immunohistochemistry were completed. Intraoral herpes virus infection and erythematous candidosis were ruled out by cytological analysis. Diagnosis of oral syphilis was confirmed with positive nontreponemal test (VDRL), and, if possible, fluorescent treponemal antibody test. Results. Twenty male patients (median age 31.5, 21–59 years) with oral secondary syphilis lesions were included. Oral lesions were the first clinical sign of syphilis in 16 (80%) cases. Mucous patch was the most common oral manifestation (17, 85.5%), followed by shallow ulcers (2, 10%) and macular lesions (1, 5%). Conclusions. Due to the recent rise in HIV-syphilis coinfection, dental and medical practitioners should consider secondary syphilis in the differential diagnosis of oral lesions, particularly in HIV-infected patients.

Oral syphilis lesions: Immunohistochemistry as a useful tool in the histopathological diagnosis

Oral syphilis lesions: Immunohistochemistry as a useful tool in the histopathological diagnosis

Oral Syphilis—Re-emergence of an Old Disease With Oral Manifestations

Oral Syphilis—Re-emergence of an Old Disease With Oral Manifestations