Head and Neck Pathology

, Volume 3, Issue 3, pp 195–206 | Cite as

Syphilis: The Renaissance of an Old Disease with Oral Implications

Invited Review

Abstract

Syphilis is caused by Treponema pallidum an anaerobic filamentous spirochete. In recent years, striking outbreaks have occurred in USA, Canada, Russia, China and some areas of Central and Eastern Europe. Main epidemiology changes reflect sex industry, sexual promiscuity, decreasing use of barrier protection (i.e. condoms) due to false sense of security that nowadays sexually transmitted diseases are curable and lack of pertinent knowledge. Considering that the initial presentation of syphilis may be the oral cavity, it is of great relevance to include this disease in the differential diagnosis of unusual oral ulcerations and white patches. Primary syphilis is a highly infectious disease in which inappropriate treatment may be apparently curative while the patient remains highly infectious. It is then of pivotal importance that clinicians maintain a high clinical index of suspicion. At the present time, clinical-pathologic correlation together with serologic studies remain essential in establishing the diagnosis of syphilis.

Keywords

Syphilis Oral cavity Treponema pallidum 

References

  1. 1.
    Hook EWIII, Marra CM. Acquired syphilis in adults. New Engl J Med. 1992;326:1060–8.PubMedGoogle Scholar
  2. 2.
    Tramont EC. Treponema pallidum (syphilis). In: Mandell GL, Benett JF, Dolin R, editors. Principles and practice of infectious diseases. 6th ed. Orlando, FL: Churchill Livingstone; 2005. p. 2768–84.Google Scholar
  3. 3.
    Sanchez MR. Syphilis. In: Wolff K, Goldsmith LA, Katz SI, Gilchrest BA, Paller AS, Leffell DJ, editors. Fitzpatrick’s dermatology in general medicine. 7th ed. New York: Mc Graw Hill; 2008. p. 1955–77.Google Scholar
  4. 4.
    Tramont EC. Syphilis in adults: from Christopher Columbus to Sir Alexander Fleming to AIDS. Clin Infect Dis. 1995;21:1361–9.PubMedGoogle Scholar
  5. 5.
    Zimmer C. Isolated tribe gives clues to the origins of syphilis. Science. 2008;319:272.PubMedCrossRefGoogle Scholar
  6. 6.
    Kent ME, Romanelli F. Reexamining syphilis: an update on epidemiology, clinical manifestations, and management. Ann Pharmacother. 2008;42:22–36.Google Scholar
  7. 7.
    Buchaz K, Greenberg A, Onorato I, et al. Syphilis epidemics and human immunodeficiency virus (HIV) incidence among men who have sex with men in the United States: implications for HIV prevention. Sex Transm Dis. 2005;32:S73–9.CrossRefGoogle Scholar
  8. 8.
    Ruan Y, Luo F, Jia Y, et al. Risk factors for syphilis and prevalence of HIV, hepatitis B and C among men who have sex with men in Beijing, China: implications for HIV prevention. AIDS Behav. 2008. doi: 10.1007/s10461-008-9503-0.
  9. 9.
    Velicko I, Arneborn M, Blaxhult A. Syphilis epidemiology in Sweden: re-emergence since 2000 primarily due to spread among men who have sex with men. Euro Surveill. 2008;13:1–5. (pii: 19063).Google Scholar
  10. 10.
    Kilmarx PH, St Louis ME. The evolving epidemiology of syphilis. Am J Public Health. 1995;85:1053–4.PubMedCrossRefGoogle Scholar
  11. 11.
    Centers for Diseases Control and Prevention. Sexually transmitted disease surveillance, 1993. Georgia: Centers for Disease Control and Prevention; 1994.Google Scholar
  12. 12.
    Druskin LM. Syphilis makes a comeback. Int J STD AIDS. 1996;7:7–9.CrossRefGoogle Scholar
  13. 13.
    Nakashima AK, Rolfs RT, Flock ML, et al. Epidemiology of syphilis in the United States, 1941–1993. Sex Transm Dis. 1996;23:16–23.PubMedCrossRefGoogle Scholar
  14. 14.
    Aral SO. The social context of syphilis persistence in the southeastern United States. Sex Transm Dis. 1996;23:9–15.PubMedGoogle Scholar
  15. 15.
    Mushinski M. Sexually transmitted diseases: United States, 1995. Stat Bull Metrop Insur Co. 1997;78:10–7.PubMedGoogle Scholar
  16. 16.
    Garnett GP, Aral SO, Hoyle DV. The natural history of syphilis. Implications for transmission dynamics and control of infection. Sex Transm Dis. 1997;24:185–200.PubMedGoogle Scholar
  17. 17.
    Center for Diseases Control and Prevention. Primary and secondary syphilis—US, 200-2001-MMWR. Morb Mortal Wkly Rep. 2002;51:971–3.Google Scholar
  18. 18.
    DHSS, PHLs and the Scottish ISD (D) 5 Collaborative Group. Sexually transmitted infections in the United Kingdom, new episodes seen at genitourinary medicine clinics, 1991–001. London: Public Health Laboratory Service; 2002.Google Scholar
  19. 19.
    Tichonova L, Borisenko K, Ward H, et al. Epidemics of syphilis in the Russian Federation: trends, origins, and priorities for control. Lancet. 1997;350:210–3.PubMedCrossRefGoogle Scholar
  20. 20.
    Muga R, Roca J, Tor J, et al. Syphilis in injecting drug users: clues for high-risk sexual behavior in female IDUs. Int J STD AIDS. 1997;8:225–8.PubMedCrossRefGoogle Scholar
  21. 21.
    Dallabetta G, Diomi MC. Treating sexually transmitted diseases to control HIV transmission. Curr Opin Infect Dis. 1997;10:22–5.CrossRefGoogle Scholar
  22. 22.
    D’Souza G, Lee JH, Paffel IM. Outbreak of syphilis among men who have sex with men in Houston, Texas. Sex Transm Dis. 2003;30:872–3.PubMedCrossRefGoogle Scholar
  23. 23.
    Hopkis S, Lyons F, Coleman C, et al. Resurgence in infections syphilis, in Ireland: an epidemiological study. Sex Transm Dis. 2004;31:317–21.CrossRefGoogle Scholar
  24. 24.
    Leber A, MacPherson P, Lee BC. Epidemiology of infectious syphilis in Ottawa. Recurring themes revisited. Can J Public Health. 2008;99:401–5.PubMedGoogle Scholar
  25. 25.
    Bissessor M, Fairley K, De Guingand D, et al. Delay in the diagnosis of early syphilis among men who have sex with men: need for greater community and health provider education. Int J STD AIDS. 2009;20:52–3.PubMedCrossRefGoogle Scholar
  26. 26.
    Fraser CM, Norris SJ, Weinstock GM, et al. Complete genome sequence of Treponema pallidum, the syphilis spirochete. Science. 1998;281:375–88.PubMedCrossRefGoogle Scholar
  27. 27.
    Radolf JD, Norgard MV, Schulz WW. Outer membrane ultrastructure explains the limited antigenicity of virulent Treponema pallidum. Proc Natl Acad Sci USA. 1989;86:2051–5.PubMedCrossRefGoogle Scholar
  28. 28.
    Peeling RW, Hook EW. The pathogenesis of syphilis: the great mimicker, revisited. J Pathol. 2006;208:224–32.PubMedCrossRefGoogle Scholar
  29. 29.
    Cox DL, Chang P, McDowall AW, Radolf JD. The outer membrane, not a coat of host proteins, limits antigenicity of virulent Treponema pallidum. Infect Immun. 1992;60:1076–83.PubMedGoogle Scholar
  30. 30.
    Lukehart SA. Scientific monogamy: thirty years dancing with the same bug. 2007 Thomas Parran Award lecture. Sex Transm Dis. 2008;35:2–7.PubMedCrossRefGoogle Scholar
  31. 31.
    Domantay-Apostol GP, Handog EB, Gabriel MTG. Syphilis: the international challenge of the great imitator. Dermatol Clin. 2008;26:191–202.PubMedCrossRefGoogle Scholar
  32. 32.
    Baughn RE, Musher DM. Secondary syphilitic lesions. Clin Microbiol Rev. 2005;18:205–16.PubMedCrossRefGoogle Scholar
  33. 33.
    Greenstone CL, Saint S, Moseley RH. A hand-carried diagnosis. N Engl J Med. 2007;356:2407–11.PubMedCrossRefGoogle Scholar
  34. 34.
    Monastirli A, Pasmatzi E, Georgiou S, Vryzaki E, Tsambaos D. Lichen-planus-like secondary syphilis in an 83-year-old woman. Clin Exp Dermatol. 2008;33:780–1.PubMedCrossRefGoogle Scholar
  35. 35.
    Kishimoto M, Lee MJ, Mor A, et al. Syphilis mimicking Reiter’s syndrome in an HIV-positive patient. Am J Med Sci. 2006;332:90–2.PubMedCrossRefGoogle Scholar
  36. 36.
    Simms I, Broutet N. Congenital syphilis re-emerging. JDDG. 2008;6:269–72.PubMedCrossRefGoogle Scholar
  37. 37.
    Schimid G, Stoner BP, Hawkes S, et al. The need and plan for global elimination of congenital syphilis. Sex Transm Dis. 2007;34:S5–10.CrossRefGoogle Scholar
  38. 38.
    Chakraborty R, Luck S. Syphilis is on the increase: the implications for child health. Arch Dis Child. 2008;93:105–9.PubMedCrossRefGoogle Scholar
  39. 39.
    Peterman TA, Furness BW. The resurgence of syphilis among men who have sex with men. Curr Opin Infect Dis. 2007;20:54–9.PubMedCrossRefGoogle Scholar
  40. 40.
    Lynn WA, Lightman S. Syphilis and HIV: a dangerous combination. Lancet Infect Dis. 2004;4:456–66.PubMedCrossRefGoogle Scholar
  41. 41.
    Zetola NM, Klausner JD. Syphilis and HIV infection: an update. Clin Infect Dis. 2007;44:1222–8.PubMedCrossRefGoogle Scholar
  42. 42.
    Blocker ME, Levine W, St Lou ME. HIV prevalence in patients with syphilis. United States. Sex Transm Dis. 2000;27:53–9.PubMedCrossRefGoogle Scholar
  43. 43.
    Branger J, Van der Meer JTM, Van Ketel RJ, et al. High incidence of asymptomatic syphilis in HIV-infected MSM justifies routine screening. Sex Transm Dis. 2009;36:84–5.PubMedCrossRefGoogle Scholar
  44. 44.
    O’Mahony C, Rodgers CA, Mendelsohn SS, et al. Rapidly progressive syphilis in early HIV infection. Int J STD AIDS. 1997;8:275–7.PubMedCrossRefGoogle Scholar
  45. 45.
    Tomberlin MG, Holton PD, Owens JL, et al. Evaluation of neurosyphilis in HIV-infected individuals. Clin Infect Dis. 1994;18:288–94.PubMedGoogle Scholar
  46. 46.
    Aldave AJ, King JA, Cunnigham ET Jr. Ocular syphilis. Curr Opin Ophtalmol. 2001;12:433–41.CrossRefGoogle Scholar
  47. 47.
    Angus J, Langan SM, Staway A, et al. The many faces of secondary syphilis: a re-emergence of an old disease. Clin Exp Dermatol. 2006;31:741–5.PubMedCrossRefGoogle Scholar
  48. 48.
    Ficarra G, Zaragoza AM, Stendardi L, et al. Early oral presentation of lues maligna in a patient with HIV infection. A case report. Oral Surg Oral Med Oral Pathol. 1993;75:728–32.PubMedCrossRefGoogle Scholar
  49. 49.
    Watson KMT, White JML, Salisbury JR, et al. Lues maligna. Clin Exp Dermatol. 2004;29:625–7.PubMedCrossRefGoogle Scholar
  50. 50.
    Bruce AJ, Rogers RS. Oral manifestations of sexually transmitted diseases. Clin Dermatol. 2004;22:520–7.PubMedCrossRefGoogle Scholar
  51. 51.
    Scott CM, Flint SR. Oral syphilis-re-emergence of an old disease with oral manifestations. Int J Oral Maxillofac Surg. 2005;34:58–63.PubMedCrossRefGoogle Scholar
  52. 52.
    Leao JC, Gueiros LA, Porter SR. Oral manifestations of syphilis. Clinics. 2006;61:161–6.PubMedCrossRefGoogle Scholar
  53. 53.
    Bacterial infections. In: Neville BW, Damm DD, Allen CM, Bouquot JE, editors. Oral and maxillofacial pathology. 3rd ed. Philadelphia: Saunders Elsevier Company; 2009. p. 181–212.Google Scholar
  54. 54.
    Junkins-Hopkins JM. Multiple painful oral ulcerations. Secondary syphilis. Arch Fam Med. 1996;5:379–80.PubMedCrossRefGoogle Scholar
  55. 55.
    Oddò D, Carrasco G, Capdeville F, et al. Syphilitic tonsillitis presenting as an ulcerated tonsillar tumor with ipsilateral lymphadenopathy. Ann Diagn Pathol. 2007;11:353–7.PubMedCrossRefGoogle Scholar
  56. 56.
    Van Crevel R, Grefte JMM, Van Doorninck D, et al. Syphilis presenting as isolated cervical lymphadenopathy: two related cases. J Infect. 2009;58:76–8.PubMedCrossRefGoogle Scholar
  57. 57.
    Cummings MC, Lukehart SA, Marra C, et al. Comparison of methods for the detection of treponema pallidum in lesions of early syphilis. Sex Transm Dis. 1996;23:366–9.PubMedCrossRefGoogle Scholar
  58. 58.
    Ratnam S. The laboratory diagnosis of syphilis. Can J Infect Dis Med Microbiolol. 2005;16:45–51.Google Scholar
  59. 59.
    Centurion-Lara A, Castro C, Shaffer JM, et al. Detection of Treponema pallidum by sensitive reverse transcriptase PCR. J Clin Microbiol. 1997;35:1348–52.PubMedGoogle Scholar
  60. 60.
    Barrett AW, Villarroel Dorrego M, Hodgson TA, et al. The histopathology of syphilis of the oral mucosa. J Oral Pathol Med. 2004;33:286–91.PubMedCrossRefGoogle Scholar
  61. 61.
    Crowson AN, Magro C, Mihim M. Treponemal diseases. In: Elder D, Elenitas R, Jaworsky C, Johnson Jr B, editors. Lever’s Histopathology of the skin. 8th ed. Philadelphia: Lippincott-Raven; 1997. p. 503–15.Google Scholar
  62. 62.
    Hoang MP, High WA, Molberg KH. Secondary syphilis: a histologic and immunohistochemical evaluation. J Cutan Pathol. 2004;31:595–9.PubMedCrossRefGoogle Scholar
  63. 63.
    Yobs AR, Brown L, Hunter EF. Fluorescent antibody techniques in early syphilis. As applied to the demonstration of T. pallidum in lesions in the rabbit and in the human. Arch Pathol. 1964;77:220–5.PubMedGoogle Scholar
  64. 64.
    Al-Sammarai HT, Henderson WG. Immunofluorescent staining of Treponema pallidum and Treponema pertenue in tissues fixed by formalin and embedded in paraffin wax. Br J Vener Dis. 1977;53:1–11.Google Scholar
  65. 65.
    Beckett JH, Bigbee JW. Immunoperoxidase localization of Treponema pallidum: its use in formaldehyde-fixed and paraffin embedded tissue sections. Arch Pathol Lab Med. 1979;103:135–8.PubMedGoogle Scholar
  66. 66.
    Meyer I, Shklar G. The oral manifestations of acquired syphilis. A study of eighty-one cases. Oral Surg Oral Med Oral Pathol. 1967;23:45–57.PubMedCrossRefGoogle Scholar
  67. 67.
    Center for Disease Control and Prevention. Sexually transmitted diseases treatment guidelines: 2006. MMWR Morb Mortal Wkly Rep. 2006;55:22–50.Google Scholar
  68. 68.
    Yinnon AM, Coury-Doniger P, Polito R, et al. Serologic response of syphilis in patients with HIV infection. Arch Intern Med. 1996;156:321–5.PubMedCrossRefGoogle Scholar
  69. 69.
    Musher DM, Hamill RJ, Baughin RE. Effect of human immunodeficiency virus (HIV) on the course of syphilis and on the response to treatment. Ann Intern Med. 1990;113:872–6.PubMedGoogle Scholar

Copyright information

© Humana 2009

Authors and Affiliations

  1. 1.Reference Center for the Study of Oral DiseasesAzienda Ospedaliero-UniversitariaFlorenceItaly
  2. 2.Department of Odonto-StomatologyUniversity of FlorenceFlorenceItaly
  3. 3.Pathology DivisionCentro Clínico de Cabeza y CuelloGuatemala CityGuatemala

Personalised recommendations