Versions
- 2024-07-12 (2)
- 2021-05-14 (1)
How to Cite
Syphilis: the great imitator. A case report and literature review. (2021). Odontoestomatología, 23(37), e401. https://doi.org/10.22592/ode2021n37a7
Abstract
Syphilis is a sexually transmitted disease caused by Treponema pallidum. Without treatment, it is chronic and highly contagious. Its varied clinical manifestations make it challenging to diagnose. We present the case of a syphilis oral lesion with a strong clinical suggestion of squamous cell carcinoma.
Clinical case:
a 31-year-old man with a large ulcer in the right lower lip mucosa with indurated edges, two months of evolution, associated with two enlarged neck lymph nodes (lymphadenopathy). A thorough history is taken, and laboratory tests are run, confirming the treponemal infection diagnosis. He was treated, and the injury resolved. Follow-up tests were nonreactive.
Conclusions
. It is important to suspect a syphilitic infection when a patient has lymphadenopathy and an oral lesion. Making the correct diagnosis allows for the proper care and recovery, avoiding complications that affect the patient’s quality of life and sexual partners.
References
1. Cohen SE, Klausner JD, Engelman J, Philip S. Syphilis in the modern era: An update for physicians. Infect Dis Clin North Am. 2013;27(4):705–22.
2. De Andrade RS, De Freitas EM, Rocha BA, Gusmão EDS, Filho MRM, Júnior HM. Oral findings in secondary syphilis. Med Oral Patol Oral y Cir Bucal. 2018;23(2):e138–43.
3. Ficarra G, Carlos R. Syphilis: The renaissance of an old disease with oral implications. Head Neck Pathol. 2009;3(3):195–206.
4. Minicucci EM, Vieira RA, Oliveira DT, Marques SA. Oral manifestations of secondary syphilis in the elderly - A timely reminder for dentists. Aust Dent J. 2013;58(3):368–70.
5. Seibt CE, Munerato MC. Secondary syphilis in the oral cavity and the role of the dental surgeon in STD prevention, diagnosis and treatment: a case series study. Brazilian J Infect Dis. 2016;20(4):393–8.
6. Brischetto A, Gassiep I, Whiley D, Norton R. Retrospective Review of Treponema pallidum PCR and Serology Results: Are Both Tests Necessary? J Clin Microbiol. 2018;56(5):e01782-17.
7. Organización Mundial de la Salud. Estrategia Mundial del Sector de la Salud contra Infecciones de Transmisión Sexual para 2016-2021. Hacia el fin de las ITS. [Internet]. Ginebra, Suiza: Organización Mundial de la Salud; 2016 [cited 2020 Jul 15]. Available from: https://www.who.int/reproductivehealth/publications/rtis/ghss-stis/es/
8. Fregnani ER, Pérez-de-Oliveira ME, Parahyba CJ, Perez DE da C. Primary syphilis: An uncommon manifestation in the oral cavity. J Formos Med Assoc. 2017;116(4):326–7.
9. European Centre for Disease Prevention and Control. Syphilis. In: ECDC. Annual epidemiological report for 2017. [Internet]. Stockholm: ECDC; 2019 [cited 2020 Jul 15]. Available from: https://www.ecdc.europa.eu/en/publications-data/syphilis-annual-epidemiological-report-2017
10.Ros-Vivancos C, González-Hernández M, Navarro-Gracia JF, Sánchez-Payá J, González-Torga A, Portilla-Sogorb J. Evolution of treatment of syphilis through history. Rev Esp Quimioter. 2018;31(6):485–92.
11.Lautenschlager S. Diagnosis of syphilis: Clinical and laboratory problems. JDDG - J Ger Soc Dermatology. 2006;4(12):1058–75.
12. Leão JC, Gueiros LA, Porter SR. Oral manifestations of syphilis. Clinics. 2006;61(2):161–6.
13. Klausner. The great imitator revealed: Syphilis. Top Antivir Med. 2019;27(2):71–4.
14. Leuci S, Martina S, Adamo D, Ruoppo E, Santarelli A, Sorrentino R, et al. Oral Syphilis: A retrospective analysis of 12 cases and a review of the literature. Oral Dis. 2013;19(8):738–46.
15. Murthy V, Vaithilingam Y, Livingstone D, Pillai A. Prosthetic rehabilitation of palatal perforation in a patient with “syphilis: The great imitator.” BMJ Case Rep. 2014;1–4.
16. Matias MDP, Jesus AO de, Resende RG, Caldeira PC, Aguiar MCF de. Diagnosing acquired syphilis through oral lesions: the 12 year experience of an Oral Medicine Center. Braz J Otorhinolaryngol. 2020;86(3):358–63.
17. Unemo M, Ballard R, Ison C, Lewis D, Ndowa F, Peeling R. Diagnóstico de laboratorio de las infecciones de transmisión sexual, incluida la infección por el virus de la inmunodeficiencia humana [Internet]. Ginebra, Suiza: Organización Mundial de la Salud; 2014 [cited 2020 Jul 15]. Available from: https://www.who.int/reproductivehealth/publications/rtis/9789241505840/es/
18. Newman L, Rowley J, Hoorn S Vander, Wijesooriya NS, Unemo M, Low N, et al. Global Estimates of the Prevalence and Incidence of Four Curable Sexually Transmitted Infections in 2012 Based on Systematic Review and Global Reporting. PLoS One. 2015;10(12):1–17.
19. Ministerio de salud. Boletín Estadístico de Enfermedades de Declaración Obligatoria en Costa Rica del año 2015 [Internet]. 2015 [cited 2020 Jul 15]. Available from: https://www.ministeriodesalud.go.cr/index.php/vigilancia-de-la-salud/estadisticas-y-bases-de-datos/notificacion-individual/3167-boletin-de-morbilidad-enfermedades-de-declaracion-obligatoria-2015-2/file
20. Coleman E, Fiahlo A, Brateanu A. Secondary syphilis. Cleve Clin J Med. 2017;84(7):510–1.
21. Peeling RW, Mabey D, Kamb ML, Chen X, David J, Benzaken AS, et al. Syphilis. Nat Rev Dis Prim. 2018;3(17073):49.
22. Sun HJ, Samet JM, Ohrr H, Jung HK, Il SK. Smoking and cancer risk in Korean men and women. Cancer Causes Control. 2004;15(4):341–8.
23. Wong TSC, Wiesenfeld D. Oral Cancer. Aust Dent J. 2018;63:S91–9.
24. Bains MK, Hosseini-Ardehali M. Palatal perforations: Past and present. Two case reports and a literature review. Br Dent J. 2005;199(5):267–9.
25. Huang S, Lu R, Yang JY, Zhou G. A nonspecific ulcer on upper lip presented as the first and sole sign of syphilis. J Infect Chemother. 2020;26(12):1309–12.
26. Zhang W, Mao Q, Lyu X, Hua H, Yan Z. Diagnosis of oral syphilis remains a challenge – A case report. Int J Infect Dis [Internet]. 2020;99:231–2. Available from: https://doi.org/10.1016/j.ijid.2020.07.049
27. Çakmak SK, Tamer E, Karadağ AS, Waugh M. Syphilis: A great imitator. Clin Dermatol. 2019;37(3):182–91.
28. Calvo DF, Cassarino D, Fernandez-Flores A. Syphilitic Chancre of the Lip. Am J Dermatopathol. 2020;42(10):e143–6.
29. Porterfield C, Brodell D, Dolohanty L, Scott G. Primary Syphilis Presenting As a Chronic Lip Ulcer. Cureus. 2020;12(2):1–7.
30. Workowski Kimberly A, Bolan Gail A C for DC and P. Sexually Transmitted Diseases Treatment Guidelines, 2015. MMWR Recomm Rep. 2015;64(33):1-137.
31. Scott CM, Flint SR. Oral syphilis - Re-emergence of an old disease with oral manifestations. Int J Oral Maxillofac Surg. 2005;34(1):58–63.
32. Report on global sexually transmitted infection surveillance, 2018 [Internet]. Geneva: World Health Organization; 2018. IGO; 2018 [cited 2020 Jul 15]. Available from: https://www.who.int/reproductivehealth/publications/stis-surveillance-2018/en/
33. Rowley J, Hoorn S Vander, Korenromp E, Low N, Unemo M, Abu-Raddad LJ, et al. Chlamydia, gonorrhoea, trichomoniasis and syphilis: Global prevalence and incidence estimates, 2016. Bull World Health Organ. 2019;97(8):548–62.
2. De Andrade RS, De Freitas EM, Rocha BA, Gusmão EDS, Filho MRM, Júnior HM. Oral findings in secondary syphilis. Med Oral Patol Oral y Cir Bucal. 2018;23(2):e138–43.
3. Ficarra G, Carlos R. Syphilis: The renaissance of an old disease with oral implications. Head Neck Pathol. 2009;3(3):195–206.
4. Minicucci EM, Vieira RA, Oliveira DT, Marques SA. Oral manifestations of secondary syphilis in the elderly - A timely reminder for dentists. Aust Dent J. 2013;58(3):368–70.
5. Seibt CE, Munerato MC. Secondary syphilis in the oral cavity and the role of the dental surgeon in STD prevention, diagnosis and treatment: a case series study. Brazilian J Infect Dis. 2016;20(4):393–8.
6. Brischetto A, Gassiep I, Whiley D, Norton R. Retrospective Review of Treponema pallidum PCR and Serology Results: Are Both Tests Necessary? J Clin Microbiol. 2018;56(5):e01782-17.
7. Organización Mundial de la Salud. Estrategia Mundial del Sector de la Salud contra Infecciones de Transmisión Sexual para 2016-2021. Hacia el fin de las ITS. [Internet]. Ginebra, Suiza: Organización Mundial de la Salud; 2016 [cited 2020 Jul 15]. Available from: https://www.who.int/reproductivehealth/publications/rtis/ghss-stis/es/
8. Fregnani ER, Pérez-de-Oliveira ME, Parahyba CJ, Perez DE da C. Primary syphilis: An uncommon manifestation in the oral cavity. J Formos Med Assoc. 2017;116(4):326–7.
9. European Centre for Disease Prevention and Control. Syphilis. In: ECDC. Annual epidemiological report for 2017. [Internet]. Stockholm: ECDC; 2019 [cited 2020 Jul 15]. Available from: https://www.ecdc.europa.eu/en/publications-data/syphilis-annual-epidemiological-report-2017
10.Ros-Vivancos C, González-Hernández M, Navarro-Gracia JF, Sánchez-Payá J, González-Torga A, Portilla-Sogorb J. Evolution of treatment of syphilis through history. Rev Esp Quimioter. 2018;31(6):485–92.
11.Lautenschlager S. Diagnosis of syphilis: Clinical and laboratory problems. JDDG - J Ger Soc Dermatology. 2006;4(12):1058–75.
12. Leão JC, Gueiros LA, Porter SR. Oral manifestations of syphilis. Clinics. 2006;61(2):161–6.
13. Klausner. The great imitator revealed: Syphilis. Top Antivir Med. 2019;27(2):71–4.
14. Leuci S, Martina S, Adamo D, Ruoppo E, Santarelli A, Sorrentino R, et al. Oral Syphilis: A retrospective analysis of 12 cases and a review of the literature. Oral Dis. 2013;19(8):738–46.
15. Murthy V, Vaithilingam Y, Livingstone D, Pillai A. Prosthetic rehabilitation of palatal perforation in a patient with “syphilis: The great imitator.” BMJ Case Rep. 2014;1–4.
16. Matias MDP, Jesus AO de, Resende RG, Caldeira PC, Aguiar MCF de. Diagnosing acquired syphilis through oral lesions: the 12 year experience of an Oral Medicine Center. Braz J Otorhinolaryngol. 2020;86(3):358–63.
17. Unemo M, Ballard R, Ison C, Lewis D, Ndowa F, Peeling R. Diagnóstico de laboratorio de las infecciones de transmisión sexual, incluida la infección por el virus de la inmunodeficiencia humana [Internet]. Ginebra, Suiza: Organización Mundial de la Salud; 2014 [cited 2020 Jul 15]. Available from: https://www.who.int/reproductivehealth/publications/rtis/9789241505840/es/
18. Newman L, Rowley J, Hoorn S Vander, Wijesooriya NS, Unemo M, Low N, et al. Global Estimates of the Prevalence and Incidence of Four Curable Sexually Transmitted Infections in 2012 Based on Systematic Review and Global Reporting. PLoS One. 2015;10(12):1–17.
19. Ministerio de salud. Boletín Estadístico de Enfermedades de Declaración Obligatoria en Costa Rica del año 2015 [Internet]. 2015 [cited 2020 Jul 15]. Available from: https://www.ministeriodesalud.go.cr/index.php/vigilancia-de-la-salud/estadisticas-y-bases-de-datos/notificacion-individual/3167-boletin-de-morbilidad-enfermedades-de-declaracion-obligatoria-2015-2/file
20. Coleman E, Fiahlo A, Brateanu A. Secondary syphilis. Cleve Clin J Med. 2017;84(7):510–1.
21. Peeling RW, Mabey D, Kamb ML, Chen X, David J, Benzaken AS, et al. Syphilis. Nat Rev Dis Prim. 2018;3(17073):49.
22. Sun HJ, Samet JM, Ohrr H, Jung HK, Il SK. Smoking and cancer risk in Korean men and women. Cancer Causes Control. 2004;15(4):341–8.
23. Wong TSC, Wiesenfeld D. Oral Cancer. Aust Dent J. 2018;63:S91–9.
24. Bains MK, Hosseini-Ardehali M. Palatal perforations: Past and present. Two case reports and a literature review. Br Dent J. 2005;199(5):267–9.
25. Huang S, Lu R, Yang JY, Zhou G. A nonspecific ulcer on upper lip presented as the first and sole sign of syphilis. J Infect Chemother. 2020;26(12):1309–12.
26. Zhang W, Mao Q, Lyu X, Hua H, Yan Z. Diagnosis of oral syphilis remains a challenge – A case report. Int J Infect Dis [Internet]. 2020;99:231–2. Available from: https://doi.org/10.1016/j.ijid.2020.07.049
27. Çakmak SK, Tamer E, Karadağ AS, Waugh M. Syphilis: A great imitator. Clin Dermatol. 2019;37(3):182–91.
28. Calvo DF, Cassarino D, Fernandez-Flores A. Syphilitic Chancre of the Lip. Am J Dermatopathol. 2020;42(10):e143–6.
29. Porterfield C, Brodell D, Dolohanty L, Scott G. Primary Syphilis Presenting As a Chronic Lip Ulcer. Cureus. 2020;12(2):1–7.
30. Workowski Kimberly A, Bolan Gail A C for DC and P. Sexually Transmitted Diseases Treatment Guidelines, 2015. MMWR Recomm Rep. 2015;64(33):1-137.
31. Scott CM, Flint SR. Oral syphilis - Re-emergence of an old disease with oral manifestations. Int J Oral Maxillofac Surg. 2005;34(1):58–63.
32. Report on global sexually transmitted infection surveillance, 2018 [Internet]. Geneva: World Health Organization; 2018. IGO; 2018 [cited 2020 Jul 15]. Available from: https://www.who.int/reproductivehealth/publications/stis-surveillance-2018/en/
33. Rowley J, Hoorn S Vander, Korenromp E, Low N, Unemo M, Abu-Raddad LJ, et al. Chlamydia, gonorrhoea, trichomoniasis and syphilis: Global prevalence and incidence estimates, 2016. Bull World Health Organ. 2019;97(8):548–62.