ORAL MANIFESTATIONS OF SYPHILIS: ESSENTIAL ASPECTSFOR THE DENTIST
DOI:
https://doi.org/10.69909/Keywords:
Syphilis, Treponema pallidum, Hutchinson teeth, Pathology, Oral, Sexually Transmitted DiseasesAbstract
Syphilis, or lues, is a chronic infectious disease
caused by the spirochete Treponema pallidum and
transmitted through sexual, via blood or placental
contact. Untreated syphilis spreads to many organs
and compromises the cardiovascular and nervous
systems, which can result in death. The aim of this
study was to describe the main aspects of syphilis for
the dentist, in order to facilitate its early identification
and management. To this end, literature searches
were carried out on the Pubmed, Embase, Lilacs and
Cochrane databases. In total, 6,265 references were
found and, after reading the titles and abstracts, 40
articles were selected for full-text reading. Syphilis
traditionally progresses in three stages. Primary
syphilis is marked by chancre, most commonly
affecting the lip. Oral manifestations are more frequent
in secondary syphilis, and consist of white mucous
patches, condyloma lata, maculopapular lesions or
split papules. In tertiary syphilis, gummas may be
present, which can cause perforations in the palate or
lesions in the tongue, such as interstitial glossitis and
luetic glossitis. Congenital syphilis, in turn, significantly
affects children’s dentition. The dentist plays an
essential role in the early identification of syphilis and
the consequent referral o specialized care.
References
1. Willeford WG, Bachmann LH. Syphilis ascendant: a brief history and modern trends. Trop Dis Travel Med Vaccines. 2016;2:20.
2. Ávila-Nieto C, Pedreño-López N, Mitjà O, Clotet B, Blanco J, Carrillo J. Syphilis vaccine: challenges, controversies and opportunities. Front Immunol. 2023;(14):1126170.
3. Forrestel AK, Kovarik CL, Katz KA. Sexually acquired syphilis: Historical aspects, microbiology, epidemiology, and clinical manifestations. J Am Acad Dermatol. 2020;82(1):1-14.
4. Deng F, Thompson LDR, Lai J. Unexpected Reason for Non-healing Oral Ulcers: Syphilis. Head Neck Pathol. 2022;16(2):544-549.
5. Khan M, Sharma A, Hathorn T, Sandhu M, Rosen R, Riddle N, et al. The Mucosal Manifestations of Syphilis in the Head and Neck. Ear Nose Throat J. 2023.
6. Zhou X, Wu MZ, Jiang TT, Chen XS. Oral Manifestations of Early Syphilis in Adults: A Systematic Review of Case Reports and Series. Sex Transm Dis. 2021;48(12):e209-e214.
7. Hook EW 3rd. Syphilis. Lancet. 2017;389(10078):1550-1557. doi: 10.1016/S0140-6736(16)32411-4. Epub 2016 Dec 18. Erratum in: Lancet. 2019;393(10175):986.
8. Ren M, Dashwood T, Walmsley S. The Intersection of HIV and Syphilis: Update on the Key Considerations in Testing and Management. Curr HIV/AIDS Rep. 2021;18(4):280-288.
9. Mercuri SR, Moliterni E, Cerullo A, Di Nicola MR, Rizzo N, Bianchi VG, et al. Syphilis: a mini review of the history, epidemiology and focus on microbiota. New Microbiol. 2022;45(1):28-34. Epub 2021.
10. Ghanem KG, Ram S, Rice PA. The Modern Epidemic of Syphilis. N Engl J Med. 2020;382(9):845-854.
11. Zheng Y, Ye K, Ying M, He Y, Yu Q, Lan L, et al. Syphilis epidemic among men who have sex with men: A global systematic review and meta-analysis of prevalence, incidence, and associated factors. J Glob Health 2024;14:04004.
12. Tao YT, Gao TY, Li HY, Ma YT, Li HJ, Xian-Yu CY, et al. Global, regional, and national trends of syphilis from 1990 to 2019: the 2019 global burden of disease study. BMC Public Health. 2023;23(1):754.
13. Medeiros YL, Guimarães IC, Melo FA, Chandretti PCS, Leite ICG, Vilela EM. Oral manifestations of syphilis: Knowledge and skills of senior dental students and newly graduated dentists. Eur J Dent Educ. 2024;28(2):497-503. Epub 2023 Nov 10.
14. Ricco J, Westby A. Syphilis: Far from Ancient History. Am Fam Physician. 2020;102(2):91-98.
15. Trovato E, Tognetti L, Campoli M, Cinotti E, Rubegni P. Syphilis Diagnosis and Treatment: State of The Art. Eur Med J. 2021.
16. Ferreira L, Dupont M, Fracastoro G, Bonati M. Girolamo Fracastoro and the Origin of the Etymology of Syphilis. Advances in Historical Studies, 2017;(6):104-112.
17. Tognotti E. The rise and fall of syphilis in Renaissance Europe. J Med Humanit. 2009;30(2):99-113.
18. Plagens-Rotman K, Jarząbek-Bielecka G, Merks P, Kêdzia W, Czarnecka-Operacz M. Syphilis: then and now. Postepy Dermatol Alergol. 2021;38(4):550-554.
19. Radolf JD, Deka RK, Anand A, Šmajs D, Norgard MV, Yang XF. Treponema pallidum, the syphilis spirochete: making a living as a stealth pathogen. Nat Rev Microbiol. 2016;14(12):744-759.
20. Peeling RW, Mabey D, Chen XS, Garcia PJ. Syphilis. Lancet. 2023;402(10398):336-346.
21. Satyaputra F, Hendry S, Braddick M, Sivabalan P, Norton R. The Laboratory Diagnosis of Syphilis. J Clin Microbiol. 2021;59(10):e0010021.
22. Atalaia-Barbacena H, Lopes CI, Lopes IM, Howell Monteiro P. Syphilitic Stomatitis: Raising Awareness on an Often-Overlooked Presentation of Secondary Syphilis. Eur J Case Rep Intern Med. 2024;11(5):004416.
23. Cao W, Thorpe PG, O’Callaghan K, Kersh EN. Advantages and limitations of current diagnostic laboratory approaches in syphilis and congenital syphilis. Expert Rev Anti Infect Ther. 2023;21(12):1339-1354.
24. Santos ES, Sá JDO, Lamarck R. Manifestações orais da sífilis: revisão sistematizada de literatura. Arch Health Invest. 2019;(8):413-416.
25. Yu X, Zheng H. Syphilitic Chancre of the Lips Transmitted by Kissing: A Case Report and Review of the Literature. Medicine (Baltimore). 2016;95(14):e3303.
26. Benainous R, Alunji M, Brillet PY, Dhote R. Pulmonary Involvement in Secondary Syphilis. Eur J Case Rep Intern Med. 2021;8(7):002487.
27. Culbert AA, Israel AK, Ku J, Silver NL. The Increasing Problem of Syphilis Manifesting as Head and Neck Cancer: A Case Series. Laryngoscope. 2024;134(1):236-239.
28. Furlan FC, Oliveira APV, Yoshioka MCN, Enokihara MMSS, Michalany NS, Porro AM. Vasculite leucocitoclástica: mais uma “imitação” da sífilis. An Bras Dermatol [Internet]. 2010;85(5):676–9.
29. Penner J, Hernstadt H, Burns JE, Randell P, Lyall H. Stop, think SCORTCH: rethinking the traditional ‘TORCH’ screen in an era of reemerging syphilis. Arch Dis Child. 2021;106(2):117-124.
30. Sankaran D, Partridge E, Lakshminrusimha S. Congenital Syphilis-An Illustrative Review. Children (Basel). 2023;10(8):1310.
31. Rocha AFB, Araújo MAL, Barros VL, Américo CF, Silva Júnior GBD. Complications, clinical manifestations of congenital syphilis, and aspects related to its prevention: an integrative review. Rev Bras Enferm. 2021;74(4):e20190318.
32. Pessoa L, Galvão V. Clinical aspects of congenital syphilis with Hutchinson’s triad. BMJ Case Rep. 2011;2011:bcr1120115130.
33. Daniel LV, Patrício UM, Quadros RM, Marques SMT. Ocorrência de treponema pallidume fatores epidemiológicos da cidade de Lages, Santa Catarina. Revista Inova Saúde. 2022;12(2).
34. Vargas SK, Qquellon J, Vasquez F, Konda KA, Calvo G, Reyes-Diaz M, et al. Laboratory Evaluation of the DPP Syphilis Screen & Confirm Assay. Microbiol Spectr. 2022;10(3):e0264221.
35. Paulo LF, Servato JP, Oliveira MT, Durighetto AFJ, Zanetta-Barbosa D. Oral Manifestations of Secondary Syphilis. Int J Infect Dis. 2015;35:40-2.
36. Thompson LDR. Oral Syphilis. Ear Nose Throat J. 2021;100(5_suppl):538S-539S.
37. Ariza Ordoñez N, Sepúlveda VG, Marín AP, Nieto LPV, León JM, Prada HAM. Leukocytoclastic vasculitis in a patient with syphilis and HIV coinfection. Rev Inst Med Trop Sao Paulo. 2022;64:e65.
38. Siu A, Landon K, Ramos D. Diferential diagnosis and management of oral ulcers. Semin Cutan Med Surg. 2015;34(4):171-7.
39. Belum GR, Belum VR, Chaitanya ASK, Reddy BS. The Jarisch-Herxheimer reaction: revisited. Travel Med Infect Dis. 2013;11(4):231-7.
40. Gautam M, Sethi S, Nadkarni NJ. Jarisch‒Herxheimer reaction. Indian J Sex Transm Dis AIDS. 2023;44(1):79-81.
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