Oral Manifestations of Early Syphilis in Adults: A Systematic Review of Case Reports and Series

Abstract

Rapid emergence of syphilis and oral sexual behaviors has focused attention on oral syphilis, and published reports of cases with oral syphilis have increased in the recent decades. We performed a systematic literature review by searching articles from PubMed, EMBSE, and Google Scholar, looking for case reports or series that would potentially have the clinical characteristics and outcomes for each individual case with oral syphilis. A total of 145 cases with the infection, from 95 studies, were identified to include in our review. Two main clinical phenotypes (ulcerative lesions and mucous patches) appeared to be of particular relevance to oral manifestations. A solitary ulcer was mostly manifested as the lesion of primary syphilis (91.7%) preferentially located on the upper lip, tongue, palate, and buccal mucosa. The most affected anatomical site in the patients with single location involved was the tongue (37.5%), followed by the lips (29.5%), palates (19.3%), and buccal mucosa (6.8%). It is concluded that oral syphilis has its predominant clinical phenotypes although it can manifest in diverse manners.S yphilis is still a major global health issue with an important burden of disease, particularly in low-income countries, in which its prevalence is highest. 1 The incidence of syphilis has increased during the last decades in many high-income countries particularly because of outbreaks of the disease among gay, bisexual, and other men who have sex with men (GBMSM). 2,3 Syphilis presents in 3 stages denoted as primary, secondary, and tertiary syphilis. A person with primary or secondary syphilis who has a sore or a rash can pass the infection to others. The primary lesion appears at the site of infection, mainly occurring on the external genitals, vagina, anus, or rectum, and secondary syphilis can result in systemic spread of the spirochetes beyond the primary infection site to affect many organs mostly presenting with dermatologic, rheumatologic, neurologic, and ocular signs. Because of the changing sexual habits particularly among GBMSM, 4 presentation of oral manifestations may rise. In recent decades, an increasing number of cases with oral syphilis have been reported. In addition, along with increasing practice of fellatio in sexual behaviors particularly among GBMSM, the mouth can be the initial site of the infection. 5 In this study, we conducted a systematic review through collecting, analyzing, and summarizing the clinical findings related to oral manifestations of early syphilis in adults from peer-reviewed studies published worldwide. MATERIALS AND METHODS Search StrategiesThe guidelines for the preferred reporting items for systematic reviews and meta-analyses statement (PRISMA) were adhered to in this systematic review. Electronic literature search was in databases of MEDLINE (via PubMed), EMBASE, Google Scholar to identify the studies matching the following combinations of MeSH Terms (syphilis OR Treponema pallidum OR T. pallidum) and keywords (oral OR mouth OR tongue OR lip) for identifying artic...

Oral Manifestations of Syphilis: Report of Four Cases

“…According to a systematic review of oral manifestations of early syphilis in adults, 62.8% of all oral lesions present in the secondary stage of syphilis. During the secondary stage of syphilis, the extra-oral manifestations will be predominately located on the skin, palm, and genital mucosa [14] as reported in Cases 1 (18-year-old female); 3 (17-year-old female); and 4 (14-year-old female).…”

“…Compared to the lesions of the primary stage, the oral lesions of secondary syphilis are typically associated with discomfort and often present affecting multiple sites. The distribution of lesions is most common on the lips and palate [14]. The uvula is only found to present with lesions in combination with other oral lesions.…”

“…Primary syphilis is acquired via direct contact with lesions of an infected individual. Upon exposure, incubation lasts approximately 21 days, with the primary lesion developing at the site of inoculation (genital area, anus, or oral cavity) as a painless papule [4,6,[12][13][14]. The characteristic sign of primary syphilis is subsequent ulceration of the papule and the development of a chancre.…”

Great imitator with exclusive oral manifestations

“…Syphilis is a sexually transmitted disease (STD), known as a great imitator for its multitudinous mucocutaneous manifestations 1–3 . Exclusive oral localization in secondary syphilis is yet uncommon 4,5 . Serologic testing for syphilis should always be considered by health practitioners in high‐risk patients as we are witnessing a re‐emergence of this STD.…”

“… 1 , 2 , 3 Exclusive oral localization in secondary syphilis is yet uncommon. 4 , 5 Serologic testing for syphilis should always be considered by health practitioners in high‐risk patients as we are witnessing a re‐emergence of this STD.…”