Oral syphilis is a chronic infectious disease caused by pale treponema. With the primary lesion, a solid chancre infiltrate is formed on the mucosa with a decay site in the center of the red color of a regular rounded shape. There are no complaints of soreness. Secondary form is characterized by the occurrence of multiple rashes of a roseolous-papular nature. The presence of gum infiltrate indicates tertiary form. Diagnosis of the disease includes clinical examination, bacterioscopy of scraping, serological reactions, radiography. Treatment of oral syphilis is carried out in a skin and venereological dispensary.
Meaning
Oral syphilis is a specific infectious disease resulting from the penetration of pale treponema into the body. In most patients diagnosed with syphilis, characteristic signs of damage to the oral mucosa, periosteum or bone tissue of the upper and lower jaws are revealed. It is often in the oral cavity that primary syphilitic foci are localized. In primary oral syphilis, 95% of patients have 1 solid chancre. It is extremely rare to form several syphilomas. During the tertiary period, gummous infiltrates that destroy bone tissue are more often detected on the lower jaw. In children and adolescents, the main ways of infection are intrauterine and domestic, whereas in older people, in most cases, infection with oral syphilis occurs due to unprotected sexual intercourse.
Causes and classification
Oral syphilis develops as a result of infection with pale treponema. The main ways of transmission of the disease are intrauterine, domestic, sexual. Predisposing conditions that open the gates for the introduction of anaerobes are skin cracks, erosion of the oral mucosa. At the site of the introduction of spirochetes, a solid chancre is formed. The reproduction of bacteria in oral syphilis occurs in the lymph nodes, as a result of which polyadenitis is observed a few days after infection. In response to the penetration of pale treponema into the body, the human immune system produces antibodies aimed at binding and eliminating infectious agents. The further spread of bacteria in the human body is carried out through the vessels of the lymphatic system.
Oral syphilis goes through 4 periods:
- Incubation. It is characterized by the absence of a specific clinic, lasts for 3-5 weeks from the moment of infection.
- Primary oral syphilis. Occurs with the appearance of primary syphiloma in the oral cavity, proceeds for 6-8 weeks. The first 3 weeks are seronegative, since with the help of specific serological tests it is not possible to isolate pale treponema. The next 3 weeks are attributed to the seropositive period.
- Secondary oral syphilis. It has been observed for 4 years. The mucous membranes, skin, and internal organs are affected. Secondary form begins with a phase of pronounced clinical manifestations lasting about 3 weeks. At the same time, multiple foci of roseolous-papular rash appear on the oral mucosa, polyadenitis is observed. Then the disease goes into a latent stage. Alternation of exacerbations and remissions can occur up to 3-4 times. Serological reactions are positive.
- Tertiary oral syphilis. Lasts for 6-8 years. The main element of the lesion is gummous infiltrate. The number of pale treponemas is significantly reduced. Serological reactions are positive in 70% of cases. Tertiary syphilis leads to irreversible destructive changes in organs and systems, causes progressive paralysis.
Symptoms
The clinic of the disease directly depends on the stage of the course of the pathological process. The primary form is indicated by the appearance of an infiltrate, in the center of which a decay zone is formed. The edges of the primary element of the lesion are regular, smooth, the bottom is red, infiltrated. When examined, the syphiloma is painless, rises slightly above the mucosa. Due to the activation of anaerobic microflora, the bottom of the ulcer is covered with a dark gray coating. More often, solid chancre is localized on the lips, tongue, palate, tonsils. A few days after the appearance of syphiloma, lymphadenitis is observed, accompanied by hyperthermia, lethargy, deterioration of the general condition.
Secondary form is characterized by the occurrence of syphilitic angina and multiple roseolous-papular elements of the lesion. Roseoles are hyperemic areas of the mucosa with clear contours. Papules are foci of mucosa altered in color (more often of a bluish-red hue) with a slight elevation in the center. The favorite localization of morphological elements in secondary form are distal areas (palate, tonsils). Papules and roseoles tend to merge, as a result of which there is a clinic that resembles a sore throat. Syphilitic lesion of the tongue manifests itself in the form of atrophy of the filamentous and grooved papillae. At the same time, the back of the tongue takes the form of a “mown meadow” – normal areas of the mucosa alternate with pathologically altered zones.
With tertiary syphilis form, a gummous infiltrate is formed. The pathological process can affect the tongue, which leads to its thickening, scarring, and persistent deformation. When the periosteum is involved in the inflammatory process, a compaction of the periosteum occurs, soldering with the mucosa. In the case of localization of syphilitic lesions in the area of the alveolar process, pathological mobility of teeth is observed, the vertical percussion of which becomes positive. When the infiltrate breaks through, a painless ulcerative crater-shaped surface with smooth edges is formed. The formation and rejection of sequesters in oral syphilis is rarely observed. Over time, the lesion area is scarred. As a result of the formation of gum on the upper jaw, a junction of the oral cavity with the nasal cavity may occur. With tertiary oral syphilis, the integrity of the bones of the nose and nasal septum is violated.
Diagnostics
The diagnosis of “oral syphilis” is based on the patient’s complaints, medical history, clinical examination, and the results of additional research methods. In primary oral syphilis, the dentist usually identifies one solid chancre. On palpation, the resulting ulcerative surface is painless, of a regular rounded shape, red in color with smooth, towering edges and an infiltrated sebaceous bottom. Lymph nodes are compacted, enlarged, painless, not soldered to the skin and surrounding tissues. With secondary form, residual syphilomas are detected, as well as a roseolous papular rash on the palate, arches, tonsils. Scraping of papules leads to the exposure of erosive surfaces. In the case of a relapse of secondary form, fewer rash elements are formed, papules and roseoles have a pale color, are grouped, forming shapes resembling garlands, lace.
With secondary syphilis form, polyadenitis is detected. Unlike catarrhal angina, pain during swallowing and a high temperature reaction in syphilitic lesions are not observed. In tertiary form, a gummous infiltrate is detected, after the disintegration of which a deep crater-like ulcerative surface is formed. The integrity of the jaws and the bones of the nose is violated. The affected areas are scarred, which leads to the appearance of persistent deformities. There is no increase in regional lymph nodes. The detection of pale treponema in the scrape or in the contents of the lymph nodes confirms the diagnosis of oral syphilis. To detect syphilitic lesions, serological reactions are also used, which in patients become persistently positive, starting from 4 weeks from the moment of formation of a solid chancre. The first 3 weeks of the course of primary oral syphilis are a seronegative period, since at this time it is not possible to confirm the diagnosis with the help of serological reactions.
Radiographically, in patients with tertiary form, bone tissue dilution zones are diagnosed in areas corresponding to a gum lesion, as well as sclerotic changes along the periphery. There is destruction of the cortical layer of bone, signs of ossifying periostitis. Differentiate oral syphilis with decubital ulcer, malignant tumor, tuberculous and actinomycotic lesions, angina, pyoderma chancriform, Setton’s aphthae, lichen planus, leukoplakia. The patient is examined by a dentist-therapist or a dental surgeon. If a specific syphilitic infection is suspected, the patient is referred for consultation to the skin and venereology department.
Treatment
Treatment of oral syphilis is carried out in a specialized venereological dispensary. Topically, washing of syphilitic lesions with antiseptics is indicated. For this purpose, chloramine-based products are more often used in dentistry. Bulging granulations are cauterized with solutions of chromic acid. If signs of pulp non-viability are detected, endodontic treatment is carried out that corresponds to the principles of therapy of chronic periodontitis. In most cases, after filling the canals, the mobility of the teeth decreases.
In the phase of severe symptoms, surgical intervention aimed at removing the formed sequesters is not performed. Sequestrectomy for oral syphilis is indicated only after the clinical manifestations of the disease subside. In the period of remission, sanitizing measures are carried out, consisting in the removal of dental deposits, the treatment of caries and its complications. With early treatment, full-fledged complex treatment, the prognosis for oral syphilis is favorable. After recovery and de-registration, the resulting defects are subject to surgical plastic surgery.
Literature
- Braun-Falko O., Plewig G., Wolff H.H., Winkelmann R.K. Dermatology. Berlin, Heidelberg, New York, London, et al.: Springer-Verlag; 1991: 81-93.
- Wolff K., Johnson R.A., Suurmond D. Fitzpatrick’s color atlas and synopsis of clinical dermatology. New York, Chicago, et al.: McGraw-Hill; 2005: 911-22. link
- Alberty R.A. Electrochemical properties of proteins and amino acids. In: Newrath H., Bailey K., eds. The Proteins. New York: Academic Press; 1963. vol. 1: 461-518.
- Lamont R.J., Burne R. A., Lantz M.S., LeBlanc D.J., eds. Oral microbiology and immunology. Washington: ASM Press; 2006. link
- Zhao T.X., Jacobson B. Quantitative correlations among fibrin-ogen concentration, sedimentation rate and electrical impedance of blood. Med. Biol. Eng. Comput. 1997; 35(3): 181-5. link
- Lydyard P.M., Whelan A., Fanger M. Instant Notes in Immunology. Oxford: BIOS Scientific Publishers; 2000.
