Alexandre Lampros1, Vannina Seta2, Phillippe Gerhardt3, Camille Isnard2, Corinne Husson4, Nicolas Dupin5. 1. Service de Dermatologie, Hôpital Cochin, Assistance Publique des Hôpitaux, Paris, France; Sorbone University, Paris. 2. Service de Dermatologie, Hôpital Cochin, Assistance Publique des Hôpitaux, Paris, France. 3. CeGIDD, Hôpital Hôtel Dieu, Assistance Publique des Hôpitaux, Paris, France. 4. Cabinet Médical, Paris, France. 5. Service de Dermatologie, Hôpital Cochin, Assistance Publique des Hôpitaux, Paris, France; CeGIDD, Hôpital Hôtel Dieu, Assistance Publique des Hôpitaux, Paris, France; Centre National de Référence des infections sexuellement transmissibles, Laboratoire associé Syphilis, Paris, France; Institut Cochin, Inserm 1016, Université de Paris, Paris, France. Electronic address: nicolas.dupin@aphp.fr.
Abstract
INTRODUCTION: Syphilis is reemerging in certain populations, such as in men who have sex with men in particular. Oral manifestations are not uncommon and can render diagnosis difficult, particularly if occurring in isolation. MATERIALS AND METHODS: We recovered clinical data for all patients receiving a diagnosis of secondary syphilis who were referred to the National Reference Center for Syphilis in Paris, France, from January 2000 to July 2019. We selected patients presenting oral symptoms only and analyzed their general characteristics, time to diagnosis, and clinical presentations. RESULTS: Secondary syphilis was diagnosed in 206 patients, 38 of whom (18%) presented oral manifestations, which were isolated in 14 patients (37%). The main oral manifestations were subacute erosive or ulcerative lesions (55%), mucous patches on the tongue (53%), and nodular (10%) and leukokeratotic lesions (5%). Mean time to diagnosis was 4.5 months, but was significantly longer for patients with isolated oral symptoms (8.8 vs 1.8 months; P = .02). CONCLUSION: Oral presentations of secondary syphilis are frequent and challenging for diagnosis, even in patients with epidemiologic risk factors. Clinicians confronted with subacute oral lesions in such patients should bear in mind the possibility of this contagious, curable, and sometimes severe disease.
INTRODUCTION: Syphilis is reemerging in certain populations, such as in men who have sex with men in particular. Oral manifestations are not uncommon and can render diagnosis difficult, particularly if occurring in isolation. MATERIALS AND METHODS: We recovered clinical data for all patients receiving a diagnosis of secondary syphilis who were referred to the National Reference Center for Syphilis in Paris, France, from January 2000 to July 2019. We selected patients presenting oral symptoms only and analyzed their general characteristics, time to diagnosis, and clinical presentations. RESULTS: Secondary syphilis was diagnosed in 206 patients, 38 of whom (18%) presented oral manifestations, which were isolated in 14 patients (37%). The main oral manifestations were subacute erosive or ulcerative lesions (55%), mucous patches on the tongue (53%), and nodular (10%) and leukokeratotic lesions (5%). Mean time to diagnosis was 4.5 months, but was significantly longer for patients with isolated oral symptoms (8.8 vs 1.8 months; P = .02). CONCLUSION: Oral presentations of secondary syphilis are frequent and challenging for diagnosis, even in patients with epidemiologic risk factors. Clinicians confronted with subacute oral lesions in such patients should bear in mind the possibility of this contagious, curable, and sometimes severe disease.