Diagnosis of secondary syphilis due to oral lesions

Abstract

Syphilis is a sexually transmitted disease caused by treponema pallidum that typically produces skin and oral lesions during the acute phase. In the chronic phase, bone, viscera, cardiovascular, and neurological manifestations may appear. Therefore, syphilis is classically divided into stages of occurrence, with each stage having its own peculiar signs and symptoms related to time and antigen-antibody responses. The stages are primary, secondary, latent, tertiary, and congenital. Oral lesions of secondary syphilis are rare, however, they may present and the dentist should be able to diagnose them. A 23-years-old white male was referred by his physician to our clinic. The oral mucosa presented several irregular, shallow ulcers, with definite limits and variable shape. Additional ulcers and red macular lesions were present in the tongue, palate and labial mucosa. In the anamnesis, the patient reported having previously palm-plantar papule-macular red lesions. Physical examination revealed no cervical or submandibular lymphadenopathy and no facial asymmetry. The patient noted that the painful, vesicular and ulcerated lesions appeared one month ago. In that moment, he also presented with asthenia, dysphagia and pain. Routine hematologic examination was normal. The patient's medical history was insignificant except for an episode of urethritis six months before. He had been treated by his physician with topical corticoids, with no favourable improvement of lesions. His medical history and clinical features were consistent with secondary luetic disease. Serologic studies supported this diagnosis. The syphilis was treated with penicillin G, with complete remission of the lesions.