Primary syphilis of oral mucosa: case report of an unusual manifestation.

Dental clinicians and other health care providers have long been concerned about a variety of infectious agents that may be transmitted within the dental setting. Many infectious diseases, including human immunodeficiency virus, hepatitis, tuberculosis, and syphilis are important both because of their potential transmissibility and because the first manifestations of the disease may appear in the oral cavity. Oral disease as a consequence of primary syphilis is rare. This article details a patient presenting with a labial nodule as her only clinical manifestation of undiagnosed primary syphilis.     

The histopathology of syphilis of the oral mucosa

BACKGROUND: Reported cases of syphilis in the United States, Europe and elsewhere are increasing in number. Clinical manifestations are protean, and oral biopsies may be taken where the diagnosis is unsuspected, but data on the histopathology of oral mucosal syphilis are sparse. METHODS: The histopathology of five oral lesions in patients with serologically proven syphilis was reviewed. RESULTS: There were two cases of primary syphilis, one secondary and two tertiary. Epithelial hyperplasia was present in three cases, and was pseudocarcinomatous in one case of primary syphilis, and psoriasiform in the secondary lesion, where heaped-up epithelium surrounded a defined crater covered by flatter epithelium. Plasma cell (primary and secondary disease) and granulomatous (tertiary) infiltrates were prominent. Other features observed were endarteritis (5/5), plasma cell neuritis (3/5) and spirochetes (4/5). CONCLUSIONS: Although no single microscopic feature is specific, a diagnosis of syphilis should be considered where there is unusual epithelial hyperplasia, granulomatous or plasma cell-predominant chronic inflammation, endarteritis and neuritis.     

Premature loss of primary teeth associated with congenital syphilis: a case report

Congenital syphilis is an infectious disease transmitted by an infected mother to her fetus. Several reports in the literature have focused on oral manifestations of congenital syphilis, mainly about Hutchinson's teeth and dysplastic molars, which are more common. However, this paper describes an unusual feature of congenital syphilis in a four-year-old child. A case of premature loss of primary teeth associated with congenital syphilis is reported.     

Oral syphilis--re-emergence of an old disease with oral manifestations

Three representative cases of oral primary syphilis are presented. We wish to highlight the resurgence of this disease, which has occurred recently in the western world, particularly in Europe and the United States of America. Since the initial presentation may be oral, it is important to include syphilis in the differential diagnosis of patients presenting to oral diagnostic clinics with atypical oral ulceration. Recent developments in the serological diagnostic tests and treatment are reviewed. Early diagnosis and treatment has significant implications, not only for the patient, but also for previous and future transmission to contacts. Early syphilis is a highly infectious disease in which the lesions heal spontaneously, despite inappropriate treatment which may appear curative, and yet the patient remains infectious. It is therefore important that clinicians maintain a high clinical index of suspicion and crucial that an accurate diagnosis be made at presentation.     

梅毒在口腔黏膜表现的临床分析——附8例报告

目的:分析梅毒在口腔黏膜的临床表现。方法:总结8例以口腔梅黏膜病损为首发症状的梅毒患者的临床特征,并结合相关文献进行临床分析。结果:8例梅毒患者中7例表现为梅毒黏膜斑,好发部位为下唇;3例表现为梅毒性黏膜炎。1例在一期梅毒时期被误诊为复发性口疮。1例儿童因父母双方均为梅毒患者而间接感染结论:梅毒在口腔的首发症状以梅毒黏膜斑最为常见。口腔医生应掌握梅毒的口腔病损,并及时对患者家属进行梅毒筛查,以免误诊,漏诊。     

Diagnostic approaches in unsuspected oral lesions of syphilis

Awareness of the increased prevalence of syphilis is essential for early diagnosis and treatment, and to prevent the spread of the disease. Although serological studies are the primary tool used to confirm the diagnosis of secondary syphilis, biopsy of unsuspected oral lesions is not uncommon in the routine oral pathology laboratory. In these cases, histopathological characteristics are likely to indicate the possibility of syphilis, and an immunohistochemical reaction can confirm it. The aim of the present study was to highlight the histological features and test the efficacy of immunohistochemistry in the detection of Treponema pallidum in oral lesions biopsied with the assumption of a non-syphilitic disease. Thirty-nine tissue samples from patients for whom the possibility of syphilis was suggested on the basis of histopathological findings, were retrieved from the surgical oral pathology service files and submitted to immunohistochemical staining for T. pallidum. The study was approved by the institutional ethics committee. Eighteen of the tissue samples were positive for T. pallidum. Following this, the contributing clinicians were contacted to check whether they had asked for serological examinations when the diagnostic report was received; for all 18 positive cases, the clinicians confirmed that the patients had tested positive at that time. This study shows the importance of clinical–pathological correlation and the value of immunohistochemistry in the diagnosis of unsuspected syphilis.     

Oral manifestations of secondary syphilis in the elderly – a timely reminder for dentists

Syphilis is a sexually transmitted infectious disease caused by Treponema pallidum. Cases of syphilis have increased in frequency and are challenging when affecting the elderly. The main causes of increased prevalence of syphilis are sexual promiscuity, lack of knowledge about the disease and decreasing use of barrier protection. Clinically, the oral manifestation of syphilis may resemble other entities, which hampers the correct diagnosis. We report a case of a 79‐year‐old male with weight loss and feeding difficulties. In the oral cavity there were ulcerative lesions in the hard palate and bilaterally in the buccal mucosa. The incisional biopsy revealed only a non‐specific ulceration of the oral mucosa. After 20 days, the patient was re‐evaluated and presented maculopapular lesions in the palmar and plantar areas. Positive serological venereal disease reference laboratory (VDRL) tests confirmed the diagnosis of secondary syphilis. The patient was treated with Benzathine penicillin G. After two weeks of treatment the oral lesion disappeared and the patient returned to normal feeding and gained weight. This case report reinforces the need to alert physicians and dentists to include sexually transmitted infections such as syphilis in the differential diagnosis of oral ulcerative lesions in elderly sexually active patients.     

Syphilis: an update

Syphilis can be spread during the practice of dentistry by direct contact with mucosal lesions of primary and secondary syphilis or blood and saliva from infected patients. The dentist also can play an important role in the control of syphilis by identification of the signs and symptoms of syphilis, patient education, and referral. The incidence of syphilis and the impact of control measures are presented with the emphasis on the past 5 years. The signs and symptoms of primary, secondary, latent, and late (tertiary) syphilis are reviewed. Current medical treatment is presented. The oral manifestations of syphilis are discussed as well as the dental management of the infected patient.     

Secondary syphilis initially diagnosed from oral lesions. Report of three cases

Three cases of secondary syphilis presenting as painful oral lesions without evidence of systemic disease are reported. In each case the oral lesions led to the diagnosis of secondary syphilis. While two of the cases had well-defined grayish white oral lesions with occasional serpentine or crescent-like configuration, the third case presented extensive oral erosive lesions with hitherto undescribed painful fissures of the tongue. The significance of oral lesions and the dentist's role in their detection are discussed.     

Secondary syphilis presenting as atypical oral ulceration--a case report

Syphilis is now regarded by many as being of historical interest only in the aetiology of oral ulceration. Its manifestations are still often classified as the classical chancre, snail track ulcers and gumma. Recent literature suggests, however, that there has been a re-emergence of syphilitic ulcers and that these need not fall into the traditional categories. Atypical ulceration with no other apparent cause should prompt investigations for possible underlying infective causes, such as syphilis, because of the increased incidence of the disease. CLINICAL RELEVANCE: It is important that clinicians maintain a high index of suspicion for syphilis when patients present with atypical oral lesions and syphilis serology should be part of the routine tests in this situation.     

Aspects of oral syphilis.

The incidence of sexually transmitted diseases recently increased in the United States and Europe due to migration, increase in high-risk behavior, and abandonment of safer sex practices at the advent of anti-retroviral combination therapy for human immunodeficiency virus infection. This article presents four cases of primary oral anti perioral syphilis with differential diagnoses. It is important to bear this reappearing infection in mind to avoid latent infection. Resembling common oral infections, the primary affect disappears spontaneously, and the infection enters the second stage. The patient remains infected, may further spread the disease, and risks severe organ damage from long-standing infection. The antibiotic cure is inexpensive and safe and spares the patient mucous patches and gumma residuals, apart from severe general sequelae such as thoracic aorta aneurysm and neurosyphilis. However, compliance problems jeopardize clinical and serologic follow-up. The growing syphilis incidence prompts the commemoration of Dr Moriz Kaposi and his dispositive 1891 book Pathology and Therapy of the Syphilis. Moriz Kaposi is acknowledged as one of the heads of the Vienna School of Dermatology, a superb clinician, and renowned teacher.     

二期梅毒40例口腔表现及病理分析

目的分析40例二期梅毒患者的口腔临床特征及病理表现。方法收集北京大学口腔医学院1994至2004年间以口腔黏膜损害首诊的40例梅毒患者，对经实验室检查确诊的临床病理资料加以分析。结果40例二期梅毒患者中32例口腔表现为相似的黏膜斑，最好发的部位是舌。疼痛症状不明显或伴有轻微疼痛。对8例最初被误诊为口腔念珠菌病和扁平苔藓的患者，组织病理学检查显示为非特异性炎症，主要表现为上皮微脓肿，固有层血管周围有密集的淋巴细胞和浆细胞浸润。16例梅毒患者经苄星青霉素治疗后症状明显好转。结论以口腔黏膜损害为首发症状的梅毒患者有其特殊的临床病理学表现，但常易被口腔医务工作者忽视。口腔科医师应认识梅毒的口腔病损，及时诊断早期梅毒。     

Systemic tuberculosis initially seen as an oral ulceration: report of case.

A 67-year-old white man was seen for the treatment of a painful oral ulceration. His medical history was highly suggestive of systemic disease. Radiographs of the chest and cultures of sputum were positive for tuberculosis. The incidence, appearance, and characteristics of oral tubercular lesions have been presented. The diagnosis of tuberculosis should be considered along with carcinoma, syphilis, fungal disease, and trauma whenever granulomatous ulcerations appear in the oral cavity.     

吸毒人群口腔黏膜疾病的调查

目的 了解吸毒人群口腔卫生习惯、个人嗜好，以及口腔黏膜病的患病情况，以期对此类人群进行早期口腔黏膜病的防治。方法 1999～2000年对厦门戒毒所200名吸毒人员进行口腔健康调查，通过询问及口腔检查了解此类人群口腔黏膜患病情况及与不良嗜好的关系。结果 200人中有125人患有9种口腔黏膜病，患病率最高为尼古丁口炎(27．5％)，其次为口干症(26．6％)，白色水肿(22．5％)。有口腔梅毒病史4例。200人均有吸烟嗜好，饮酒者190人，嗜酒者32人，占16％。结论 吸毒人群是不良嗜好的高发人群，是口腔黏膜病的高发人群，是性病高发人群。     

Eosinophilic ulcer of oral mucosa: a case report

Eosinophilic Ulcer (EU) is a rare self-limiting chronic benign lesion of the oral mucosa with pathogenesis still unclear, however it may resemble malignancies, traumatic ulcerations and some infections such as deep fungal infections, tuberculosis and primary syphilis. This is a case report of a patient with EU in the lateral border of the tongue with no history of associated trauma and refractory to treatment with drugs. The ulcer rapidly healed after an incisional biopsy and the definite diagnosis was achieved only combining histologic findings and the clinical follow-up.     

Rethinking prevention

The purpose of this paper was to present information that underscores: (1) the need for understanding the fundamental nature of dental caries; and (2) efforts to minimize its consequences in light of available scientific evidence, recent population trends, and persistent pressures to extend improvements in oral health to all children in the most cost-effective manner. The primary emphasis was placed on the importance of appreciating caries as a common, complex, chronic disease whose deleterious effects can be mitigated best with ongoing use of appropriate, risk-based protective measures. Additional attention was given to current and emerging challenges along with considerations for aligning oral health promotion and delivery system capacity with children's oral health care needs.     

Secondary syphilis with extensive oral manifestations

A bstract — Although oral syphilis is uncommon, it is, however, a potential health risk to dentists who are usually unfamiliar with this clinical entity. The following case report highlights the problems that could arise when dentists are confronted with clinical cases of secondary syphilis with oral affection.     

Oral fungal and bacterial infections in HIV-infected individuals: an overview in Africa

Oral opportunistic infections developing secondary to human immunodeficiency virus (HIV) infection have been reported from the early days of the epidemic and have been classified by both the EC-Clearinghouse and the World Health Organisation (WHO). Among the fungal infections, oral candidiasis, presenting in African HIV-infected patients has been sporadically documented. We review the literature with respect to candidal carriage, oral candidiasis prevalence and the predictive value of oral candidiasis for a diagnosis of underlying HIV disease in African HIV-infected patients. The use of oral candidiasis as a marker of disease progression, the species of yeasts isolated from the oral cavity in Africa and the resistance of the yeasts to antifungal agents and treatment regimens are discussed. Orofacial lesions as manifestations of the systemic mycoses are rarely seen in isolation and few cases are reported in the literature from Africa. In spite of the high incidence of noma, tuberculosis, chronic osteomyelitis and syphilis in Africa, surprisingly there have been very few reported cases of the oral manifestations of these diseases in HIV-positive individuals. Orofacial disease in HIV-infected patients is associated with marked morbidity, which is compounded by malnutrition. The authors indicate specific research areas, initially directed at the most effective management strategies, which would complete data in this important area.     

PL10Oral manifestations of orogenital bacterial infections

Orogenital sex in the last decades has become a common sexual practice (fellatio and cunnilingus) between both heterosexual and homosexual individuals. Consequently, several sexually transmitted diseases (STDs) including bacterial infections, are a persistent problem in Europe and throughout the world, despite vigorous efforts in prevention and people education. The last two decades, HIV infection, revived the interest of the medical community and the people for the sexually transmitted diseases. Many of these bacterial infections present predominantly with characteristic oral signs and symptoms. As a result, it is imperative for the oral physician (stomatologist) to keep abreast of the latest updates in the behavior and to be aware of the whole spectrum of clinical manifestations of these diseases. Orogenital bacterial infections may be divided into two major categories: (i) Common including syphilis and gonorrhoea and (ii) Rare, including chlamydia trachomatis infection and tropical sexually transmitted infections (chancroid, donovanosis, lymphogranuloma venereum). Syphilis is the leader of sexually transmitted diseases and has been of great interest in the past and today and has played a central role in medicine for several decades. The oral lesions of syphilis (primary secondary and tertiary stages) have a broad spectrum of manifestations, which mimic a lot of other oral lesions. The recent incidence data, the oral manifestations, the laboratory tests and treatment of both categories of these diseases will be discussed, as the increased practice of oral sex has become a more important potential route of transmission for oral and genital bacterial pathogens. Stomatologists and Dentists, frequently evaluate oral mucosal manifestations and thus play an important role in the diagnosis and treatment of many of highly infectious sexually transmitted infections.     

Keratonodular tonsillitis.

Reported is an unusual lesion on the right palatine tonsil in a man with latent primary syphilis. The lesion was white, nodular, firm, and asymptomatic, and histologically had a keratinized surface; it was not caused by primary syphilis or any other known or described entity. The term keratonodular tonsillitis has been coined to designate this lesion of unknown cause or significance.