Exposing the Great Imitator: Proposal for a Holistic Diagnosis of Oral Secondary Syphilis in People Living with HIV

Ramírez‐Amador, Velia; Castillejos-García, Itzel; Maldonado‐Mendoza, Jessica; Saeb‐Lima, Marcela; Aguilar‐León, Diana; Anaya‐Saavedra, Gabriela

doi:10.1007/s12105-022-01446-5

Cited by 2 publications

(5 citation statements)

References 34 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…In this recent observational study, the authors highlighted a predilection of oral syphilis lesions for specific oral sites, in detail, the soft palate, uvula, and oropharynx, followed by the tongue, hard palate, buccal mucosa, and labial mucosa. Additionally, in contrast to the presented symptomatic case, 95.7% of the cases reported by Ramírez-Amador et al were asymptomatic [11].…”

Section: Discussioncontrasting

confidence: 71%

“…To our knowledge, to date in the literature, only one study has described the manifestations of oral syphilis infection in patients living with HIV. However, it is important to note that many of the patients reported in that study exhibited additional cutaneous signs, such as a maculopapular rash on the trunk, palmar and plantar lesions, and alopecia in the eyebrows and eyelashes, in addition to the oral lesions [11]. In this recent observational study, the authors highlighted a predilection of oral syphilis lesions for specific oral sites, in detail, the soft palate, uvula, and oropharynx, followed by the tongue, hard palate, buccal mucosa, and labial mucosa.…”

Section: Discussionmentioning

confidence: 90%

“…Regarding the clinical findings of syphilis infection, oral manifestations are a welldocumented occurrence in secondary syphilis, although they can manifest at any stage of the disease [5]. The clinical presentation of oral syphilis lesions is highly heterogeneous; for this reason, syphilis is often defined as "the great imitator" [9,11]. Generally, oral syphilis manifestations appear as erosive and/or ulcerative lesions or mucous patches [21].…”

Section: Discussionmentioning

confidence: 99%

“…Therefore, considering the significant variability in the clinicopathological presentation of oral syphilis, it is fundamental, in our opinion, to be aware of syphilis clinical and histopathological features in order to schedule all the necessary tests to achieve an early diagnosis and subsequent adequate management [11], for the reason that untreated syphilis infection can lead to irreversible neurological and cardiovascular complications, and it is associated with a reported mortality rate ranging from 8% to 14% [10].…”

Section: Discussionmentioning

confidence: 99%

“…Given the wide variety of symptoms that characterize it, syphilis is also known as "the great imitator" [9]. The "great imitator" appears not only in the clinic but also in histopathology, since oral secondary syphilis may mimic various infectious, neoplastic, or immune-mediated processes [11]. Early diagnosis of syphilis infection is essential for adequate management, particularly in people living with HIV as it aids in appropriate management and prevents further complications.…”

Section: Introductionmentioning

confidence: 99%

See 4 more Smart Citations

Oral Secondary Syphilis in an HIV-Positive Transgender Patient: A Case Report and Review of the Literature

Mauceri,

Coppini,

Cascio

et al. 2023

Dentistry Journal

View full text Add to dashboard Cite

Background: Syphilis is a worldwide sexually transmitted infection caused by Treponema pallidum. In most cases, the oral manifestations of syphilis infection are associated with cutaneous involvement. However, the present case report is noteworthy since the oral lesions are the sole clinical sign in an HIV-positive transgender patient. Case presentations: We reported an uncommon case of secondary syphilis in a 37-year-old seropositive transgender male, whose diagnostic suspect was based only on oral mucosal lesions. The patient was referred to the Oral Medicine Unit for the presence of multiple undiagnosed painful oral lesions. The intraoral examination revealed the presence of white and red plaques on the right and the left buccal mucosa and several painful lesions localized on the upper and lower labial mucosa. No cutaneous lesions were observed. Considering the sexual history of the patient and clinical findings, secondary syphilis infection was suspected. The serologic analysis was conducted, and the diagnosis of syphilis was confirmed. Moreover, to exclude the presence of oral epithelial dysplasia or malignant disease, an incisional biopsy was performed. Discussion: Compared to the literature data, oral lesions as lone signs of secondary syphilis infection are uncommon, especially in HIV-positive patients. Syphilis and HIV coinfection create a concerning situation as they interact synergistically, leading to an increased risk of transmission and faster disease progression. Conclusions: This case report emphasizes the importance of considering syphilis as a diagnostic possibility, even when oral lesions are the only clinical manifestations, especially in HIV-positive patients. Comprehensive evaluation, including a detailed sexual history and careful oral examination, is essential for accurate diagnosis and appropriate management in such cases.

show abstract

Section: Discussioncontrasting

confidence: 71%

Section: Discussionmentioning

confidence: 90%