INDIAN DENTAL ACADEMY
Leader in continuing Dental Education
Syphilis is an acute and chronic sexually transmitted
disease (STD) caused by spirochete Treponema pallidum
that produces skin and mucous membrane lesions .
•The oral cavity is the most common extra genital
site of syphilis infection. Oral lesions in secondary
stage syphilis are particularly common when
associated with general symptoms and cutaneous
•However, the exclusive oral localization, not
associated with general manifestations, is
uncommon. We report a case of oral ulceration as
the sole presentation of secondary syphilis.
•Overlying epidermis is moderately
hyperplastic and keratinized, focally
ulcerated and covered with exudate.
•There is dense dermal and
conspicuously perivascular (both in
superficial and deep dermis) plasma
cell lymphoplasmacytic infiltrate
present with an ill defined collection of
histiocytes and perineural infiltrate
•ELISA TEST FOR HIV
SECONDARY SYPHILITIC LESIONS
INVOLVING BUCCAL AND LABIAL MUCOSA
The name syphilis was coined by Italian physician
and poet Girolamo Fracastoro in his epic noted
poem, written in latin , entitled “Syphilis sive
morbus glallicus” (Latin for “Syphilis or the French
disease”) in 1530.
• Syphilis is caused by Treponema pallidum, a
spirochete, and is characterized by episodes of
active disease interrupted by the period of latency.
•This is a gram positive, motile, slender, fragile,
microcephalic spirochete is pathogenic to humans
demonstrated by the dark field microscope with a
•High rates of tuberculosis, HBV and syphilis
among HIV infected persons are reported.
Mahajan A et al
•Prevalence of syphilis was highest (22%) sexually
transmitted infections among sex workers
Thakor H.G et al.
•In the past, there was a male predominance of 3.5:1
but at present the male to female ratio is approximately
1:1 due to elevated rates of syphilis among women
involved in prostitution related to crack cocaine.
•Transmission occurs via oral-genital, oral-anal, or
other sexual contact with contaminated material, and
Soares A.B et al
• Syphilis can be classified as either congenital or
acquired which can be primary, secondary, latent
and tertiary , depending on the elapsed time after
• The secondary stage, usually commencing about six
to eight weeks after primary lesion is characterized by
fever, arthralgia, malaise and generalized eruptions of
the skin and mucous membranes.
•The oral lesions arise in at least 30% of patients
with secondary syphilis and rarely oral ulceration
may be only manifestation of infection with the
absence of skin lesions.
Leao J.C et al
•Mucous membrane lesions tends to be oval- to-
crescentric erosions or shallow ulcers of about 1 cm
diameter, covered by a grey mucoid exudates and
with an erythematous border.
•The patches usually arise bilaterally on the mobile
surfaces of mouth, although the pharynx, gingiva,
tonsils, and very rarely the hard palate can be
Leao J.C et al
Non-treponemal serologic test are
#Venereal Disease Research Laboratory (VDRL)
#Rapid Plasma Reagin (RPR)
Treponemal serologic tests are
#Fluorescent Treponemal Antibody absorption (FTA-
#Treponema Pallidum Haemagglutination Assay
#Enzyme immunoassay (EIA).
•Plasma cell infiltration is the key microscopic
features in primary and secondary disease and
perivascular infiltrate with a preponderance of
plasma cells are, however , common in oral biopsies
which extends deeply into sub mucosa that should
perhaps bring the diagnosis to mind.
Barrett A.W et al
•The current medical management of syphilis
includes the use of long acting Benzathine
penicillinG,2.4 million units intramuscularly in
• Alternate drugs for patients include oral
doxycycline or tetracycline.
James W Little
Prevalence of sexually transmitted diseases apparently are
far higher in developing countries because of lack of
awareness and treatment is less accessible.
Syphilitic lesion is prone to be misdiagnosed therefore it
should be considered under the differential diagnosis of
“chronic, multiple, recurrent, shallow, ulcerative and
scrapable white lesions with erythematous border”.