ORAL
and maxillofacial pathology diagnosis and management—from page 234
Diagnosis: Mucous Patch-secondary Syphilis Discussion Based on the clinical findings, location of the lesions and the patient’s medical history, a differential diagnosis should include mucous patch as a manifestation of secondary syphilis; chronic hyperplastic candidiasis, leukoplakia, and pseudomembranous pharyngitis are also considered. Syphilis: Syphilis, caused by the Spirochete Treponema pallidum, is one of the common sexually transmitted diseases noted in the United States.1,2 Mucous patch is the classic oral manifestation of secondary syphilis which develops 2-12 weeks after the initial infection and 8-weeks after the resolution of primary syphilis. Since reaching a historic low in 2000 and 2001, there has been a resurgence in syphilis incidence in the United States, especially among males who have sex
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with men (MSM).1,2 Multiple sexual partners, decreasing use of barrier protection (i.e., condom), illicit drug use, alcohol abuse, and HIV coinfection are the major risk factors for contracting syphilis.1,2 The transmission of T. pallidum usually occurs via sexual contact.3,4 These organisms penetrate the skin and mucosal barriers via oral or genital mucosal breeches during sexual activity. Once entered through the skin or mucosa, T. pallidum disseminates rapidly to the regional lymph nodes.2,4 If left untreated, it undergoes systemic dissemination via the bloodstream and progresses to secondary syphilis.2,4 Untreated syphilis can progress over years through a series of clinical stages and have serious potentially lifealtering and irreversible health consequences such as neurological complications, hearing loss, blindness, and an increased likelihood of contracting
Texas Dental Journal | Vol 139 | No. 5
other sexually transmitted diseases.2 Pregnant females with syphilis infection can give birth to babies with congenital syphilis, as well as suffer from an increased risk of miscarriage, stillbirth, birth defects, and/ or infant death.2 Although deaths from syphilis in the adult population are rare, a 6.5% case-fatality rate has been reported for babies born with congenital syphilis. Primary Syphilis: Primary syphilis, which presents as a chancre, develops the site of the bacterial organism’s entry and presents as a painless, red, indurated ulcer. Primary syphilis usually appears on the genitalia, but may be present on other sites such as the anus or oral cavity. The chancre heals on its own in a few days to weeks, even without treatment. The lips are the most common site of primary syphilis of the oral cavity, followed by the tongue and tonsillar area.
