SYPHILIS

Dr Muniba Saleem
 Syphilis

 Syphilis is a sexually transmitted disease and the causative

bacterial agent is Treponema pallidum.

 Gains entry to the body via mucous membranes and minute

abrasions in the skin.
 The incidence in Western countries has now declined significantly

 There is a popular misconception that syphilis is a rare disease but

it is a common infection in Russia and the Far East and its incidence
worldwide is increasing.

 Outbreaks of cases continue to be reported in the UK and oral

lesions of syphilis may be seen in the oral medicine clinic

 Early diagnosis is essential as the long-term effects of untreated

syphilis are serious and potentially life-threatening.
 Syphilis

A. Primary

B. Secondary

C. Tertiary

D. Latent

E. Congenital
 Primary syphilis

 The primary lesion ----chancre

 usually occurs on the genital area .

 May present on the oral mucosa, usually the lip

 Appears following a period of 2 to3 weeks after infection.

 Chancre presents as a painless, shallow ulcer with indurated base),

 Continued…

 Soft and unrestricted tissues

 Tongue, cheeks, or lips

 But where they occur on the palate or gingivae the morphology

of the lesions may be modified, and they may appear as more

diffuse structures.
 Note

 Whatever the site, size, or shape of the chancre, however, the

heavy infection of the surface is consistent, thus providing both a

convenient means of diagnosis and a considerable hazard to the

unsuspecting diagnostician particularly if gloves are not worn

 Other clinical features

 At the time of the primary lesion there is a non tender

enlargement of the cervical lymph nodes affecting the sub

mental, submandibular, pre- and post-auricular, and occipital

groups the so-called syphilitic collar.

 Histopathology

 The chancre consists of ulcerated granulation tissue

 With a dense mononuclear inflammatory cell infiltrate chiefly

composed of plasma cells.

 It heals spontaneously within a 2-6 week period.

 Secondary syphilis

 This disappearance of the primary lesion, usually after a period

of some 2 weeks, marks the widespread dissemination of the

micro-organisms and the onset of the second stage of the

disease, which may last for many years

 signs and symptoms

 Develop about 6 weeks after the appearance of the primary chancre

 Some time, 2-3 months after the initial exposure

 A generalized skin rash

 oral lesions of which called mucous patches

 'Mucous patches' are flat areas of ulceration.

 multiple and may coalesce to produce lesions of irregular outline

called 'snail-track ulcers'.

 Mucous patches

 grey-white ulcers covered by a thick slough

 snail track ulcer

 In this second stage lymph nodes may again be palpable as non

tender, discrete structures

 Tertiary stage syphilis

 Develop many years after the initial exposure

 Two major forms of oral involvement may occur.

 syphilitic leukoplakia

 development of a gumma
 Gummas

 Gummas (areas of necrosis associated with delayed (type IV)

hypersensitivity reactions to syphilitic antigens)

 A chronic granuloma, often in the palatal tissues, that eventually

breaks down with the consequent production of a tissue defect

 Occur, especially on the hard palate, leading to perforation into

the nasal cavity
 Histopathology

 A gumma consists of a central mass of coagulative necrosis

 surrounded by granulation tissue

 Infiltrated by lymphocytes, plasma cells, and macrophages with

 Occasional giant cells.

 Spirochaetes are very scanty or absent

 Syphilitic leukoplakia

Leukoplakia is currently defined as a

predominantly white lesion of the oral
mucosa that cannot be characterized
as any other definable lesion
 Late syphilis

 CNS involvement

 CVS involvement

 Brain involvement
 Oral manifestation of tertiary, late syphilis

 Atrophic glossitis

 Fibrosing glossitis

 Osteomyelitis

 Ca tongue

 Endarteritis obliterans is thought to be the cause of the atrophy

 the smooth surface of the tongue being broken up by fissures

resulting from atrophy and fibrosis of the tongue musculature.

 Congenital syphilis

 Treponema pallidum crosses the placental barrier and causes

congenital syphilis in the fetus.

 Congenital syphilis

 rare

 but in some community groups, such as drug abusers or those

with lack of prenatal care

 it is still an important cause of miscarriage, stillbirth, or neonatal

infection
 Oral / extra oral manifestation

 affect the permanent dentition

 Hutchinson's incisors

 Mulberry or Moon's molars

 saddle deformity of the bridge and the 'dished' appearance of

the face
 Dental abnormalities

 The maxillary central incisors are most frequently involved and are
characterized by

 Central notching of the incisal edge and a tapering 'screwdriver'

appearance.

 Mulberry molars, usually the first permanent molars, are

characterized by hypo plastic defects of the occlusal surface

 and defective cusp development with rounded, globular masses of

hard tissue producing their mulberry appearance.
 Nose deformity

 Collapse of the bridge of the nose, due to infection and

destruction of the developing nasal bones,

 produces the characteristic saddle deformity of the bridge and

the 'dished' appearance of the face

 The diagnosis of syphilis

 Serological test
Serological tests currently used to diagnose syphilis

Test Abbreviation
Venereal Disease Reference VDRL
Laboratory test
Treponema pallidum haem TPHA
agglutination assay
Fluorescent Treponema antibody FTA
absorbed test
Treponema pallidum immobilization TPI
test
 Treatment

 Penicillin ----------in high doses.

 In primary syphilis the course of antibiotics is up to 1 month

 late (or latent) syphilis the course------12 weeks.

 Patients who are allergic to penicillin can be prescribed

erythromycin or tetracycline
Summary ..

 Syphilis
 Etiology
 Types
 Clinical features
 Management