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

The challenging diagnosis of overlapping oral primary/secondary syphilis with nonreactive serology

“…Clinically, in primary syphilis, oral lesions are ulcerated and asymptomatic in both HIV‐positive 4 and non‐HIV‐positive patients, 18‐22 as in our case. However, in secondary syphilis, oral lesions have a heterogeneous pattern, including the presence of typical mucous patches or superficial ulcers in both HIV‐positive 4‐6 and non‐HIV‐positive patients, 19,21,23‐26 a clinical presentation observed in the early stage in our patient.…”

“…DISCUSSIONThe relevance of this case lies on its unusual presentation in clinical, histopathological, and serological terms, and alerts the clinician about the possibility of syphilis even in the absence of seroconversion. The present case illustrates consideration for syphilis in persistent chronic infiltrates that cannot be otherwise explained.Clinically, in primary syphilis, oral lesions are ulcerated and asymptomatic in both HIV-positive4 and non-HIV-positive patients,[18][19][20][21][22] as in our case. However, in secondary syphilis, oral lesions have a heterogeneous pattern, including the presence of typical mucous patches or superficial ulcers in both HIV-positive 4-6 and non-HIV-positive patients,19,21,[23][24][25][26] a clinical presentation observed in the early stage in our patient.…”

“…3 In people living with HIV (PLWH), oral primary syphilis occurs rarely on oral mucosa, with the labial mucosa and the tongue being the most frequent sites for chancre presentation. 4 Hence, most of the syphilitic lesions described in mouth correspond to secondary syphilis, particularly the well-known grayish-white mucous patches, and the superficial ulcers that can occur anywhere on the oral mucosa. [4][5][6] The occurrence of false-negative syphilis serology in both primary and secondary syphilis in PLWH is relevant.…”

“…4 Hence, most of the syphilitic lesions described in mouth correspond to secondary syphilis, particularly the well-known grayish-white mucous patches, and the superficial ulcers that can occur anywhere on the oral mucosa. [4][5][6] The occurrence of false-negative syphilis serology in both primary and secondary syphilis in PLWH is relevant. 3 In routine care, besides clinical and histopathological characteristics, diagnosis is confirmed mainly by serological tests, such as the Venereal Disease Research Laboratory (VDRL), and the fluorescent treponemal antibody absorption (FTA-ABS) test.…”

Sífilis: uma revisão da literatura

“…Segundo estes, a maior parte dos pacientes foi diagnosticada na terceira (40 a 47%) e quarta (21 a 24,7%) décadas de vida, sendo que o número de mulheres afetadas na segunda década foi mais alta do que de homens, o que enquadraria na possibilidade de transmissão caso houvesse uma gestação na adolescência. Referente às lesões orais, a maioria eram úlceras ou placas únicas, com os lábios e a língua representando os locais mais afetados (Matias et al, 2019).…”