Syphilis is a sexually transmitted infection caused by the bacterium Treponema pallidum. It is spread through direct contact with a syphilis sore, usually during vaginal, oral or anal sex. Syphilis progresses through four stages: primary, secondary, latent and tertiary. Each stage has distinctive signs and symptoms that can appear on the mouth.
During the primary stage, the first sign of syphilis is a small, painless sore known as a chancre. Chancres transmit the disease very efficiently, and they typically appear at the site of infection within 10 to 90 days. Oral chancres specifically develop on or around the lips, tongue, under the tongue and on the sides of the mouth. Without treatment, they last 3 to 6 weeks and heal on their own.
The secondary stage begins when the primary chancre heals. Secondary symptoms arise as the bacteria spreads through the bloodstream. At this stage, syphilis may cause sores on the mouth, lips or tongue. These sores are usually not painful but are highly contagious. Additional oral symptoms can include patchy white spots or a “warty” texture on the tongue, tonsils and roof of the mouth.
After the secondary stage, syphilis transitions to the latent and late stages when there are no visible symptoms. However, without treatment, syphilis can seriously impact the mouth, brain, heart, nervous system, bones, joints and other areas over time.
What Does a Primary Syphilis Chancre Look Like in the Mouth?
The primary chancre is the first sore that develops during the initial stage of syphilis infection. Chancres signal the start of the disease and they are incredibly infectious. Oral chancres specifically occur on the lips, under the tongue, on the sides of the mouth, on the gums, and sometimes on the tonsils or the roof of the mouth.
Here are the main characteristics of oral syphilis chancres:
Appearance
– Round, open sore
– 0.3 cm to 3 cm in diameter
– Painless
– Firm border
– Reddened base that bleeds easily
– Gray/white coating over sore
Location
– Lips
– Tongue
– Under tongue
– Sides of mouth
– Gums
– Tonsils
– Roof of mouth
Duration
– Appears 10-90 days after infection
– Lasts 3 to 6 weeks
– Heals on its own without treatment
So in summary, the primary chancre is a small, round and painless ulcer with a reddish appearance and defined borders. It goes away after a few weeks but it is highly contagious during this time. Proper treatment must be started as soon as possible to kill the syphilis bacteria and prevent progression to later stages.
What Does Secondary Syphilis Look Like in the Mouth?
The secondary stage of syphilis develops approximately 4 to 10 weeks after the primary chancre heals and when it has not been treated properly. At this point, the bacteria spreads through the bloodstream and begins to impact multiple organs. Oral symptoms during secondary syphilis may include:
Mucous Patch Lesions
– Flat or slightly raised round spots
– Size of a penny
– Gray or white in color
– Occur in warm, moist areas of the mouth
– Spread easily during oral sex
Condylomata Lata
– Painless, moist, white or gray lesions with a flat base and raised border
– Resemble warts or canker sores
– Develop on lips, tongue, tonsils, roof of mouth
Additional Symptoms
– Reddened sore throat with patchy white spots
– Swollen lymph nodes under jaw
– Fever, fatigue, headaches
– Patchy hair loss on scalp
– Rash on palms of hands and soles of feet
At this stage, syphilis is highly infectious. Without antibiotic treatment, the symptoms will eventually resolve after 3 to 6 weeks. But the infection will still progress silently to later stages.
What Does Tertiary Syphilis Look Like in the Mouth?
Tertiary syphilis develops around 3 to 15 years after initial infection. At this stage, the disease can cause severe internal organ damage and debilitating neurological problems since it has been left untreated. Some oral/facial symptoms during tertiary or late-stage syphilis include:
Gummas
– Firm, rubbery lesions that vary in size
– Develop on the roof of the mouth, tongue, lips, inside cheeks or nose
– Cause tissue destruction when they rupture
Rhagades
– Deep cracks or fissures on corners of the mouth
– Often bleed and cause pain
Saddle Nose Deformity
– Sunken bridge of nose due to damage to nasal cartilage and bones
Auditory Problems
– Tinnitus or ringing in the ears
– Gradual hearing loss
Neurosyphilis
– Headache, difficulty coordinating muscle movements
– Loss of sensation and paralysis
– Dementia, personality changes
Tertiary syphilis is serious, life-threatening and can damage the brain, heart, liver, bones and joints over time. Immediate treatment is critical.
How to Recognize Oral Syphilis
Since syphilis sores can resemble other conditions like canker sores or oral thrush, it is important to recognize the unique characteristics of syphilis.
Here are tips to help identify oral syphilis:
– Note the appearance – syphilis chancres and lesions tend to be uniformly round/oval with a definite border.
– Check the location – syphilis sores favor the lips, tongue and warm moist tissues of the mouth.
– Consider sexual history – syphilis risk is higher with a new partner or multiple partners.
– Review timeline – syphilis symptoms appear at predictable times after infection.
– Assess for pain – syphilis mouth sores are usually not painful.
– Look for other symptoms – fever, rash, hair loss and sore throat can accompany oral syphilis.
– Test for syphilis – a blood test can confirm diagnosis and rule out conditions like herpes or canker sores.
Early testing and treatment are vital, as syphilis lesions are highly infectious. Left untreated, syphilis bacteria will continue to spread and advance through the deadly tertiary stage.
Treatment for Syphilis in the Mouth
The primary treatment for syphilis is intramuscular benzathine penicillin injections. For early stage syphilis, one injection may be sufficient. Late stage syphilis requires multiple doses over several weeks.
Here is an overview of syphilis treatment regimens:
Primary, secondary and early latent syphilis
– Benzathine penicillin G 2.4 million units IM for 1 dose
Late latent syphilis or latent syphilis of unknown duration
– Benzathine penicillin G 2.4 million units IM for 3 doses at 1 week intervals
Tertiary syphilis
– Benzathine penicillin G 2.4 million units IM for 3 doses at 1 week intervals
– May require additional treatments
– Evaluate for neurosyphilis and cardiac involvement
Oral antibiotic therapy may be used as an alternative in penicillin-allergic patients. But penicillin is preferred as resistance can occur with other drugs.
After starting treatment, chancres and oral lesions typically resolve within 2-6 weeks. It is important to avoid sexual contact until sores have completely healed. Follow up testing is also critical to confirm a complete cure.
Complications of Oral Syphilis
Syphilis can lead to serious complications when mouth sores and lesions are left untreated:
Spread of Infection
Active oral chancres and lesions allow syphilis to spread rapidly to sexual partners. The open sores and blisters contain large amounts of bacteria that are easily transmitted through oral and sexual contact.
Progression to Later Stages
Without proper antibiotic treatment, syphilis will advance from the primary and secondary stages into the debilitating tertiary or late stage.
Oral Cancer
Mouth ulcers that persist over longer periods of time can lead to DNA mutations and cancerous changes in the affected cells.
Tooth and Bone Loss
Late stage gummas and rhagades may erode teeth and surrounding oral structures.
Facial Disfigurement
If cartilage and bones are damaged by tertiary syphilis, it can cause irreversible deformities of the face and nose.
Systemic Complications
If syphilis spreads throughout the body via the bloodstream, it can severely damage the brain, heart, liver, joints, eyes and other areas over time. This can result in issues like dementia, blindness, impaired mobility and even death.
That is why early syphilis testing and treatment are so critical, before the infection has a chance to advance and cause widespread organ damage.
Prevention of Oral Syphilis
Here are some key tips to help prevent syphilis transmission through oral sex or other types of mouth-to-mouth contact:
– Use barrier protection like condoms, dental dams or plastic wrap during oral sex.
– Avoid kissing or oral contact with any questionable sores or lesions.
– Get tested regularly for syphilis, especially with new partners – this allows early treatment if detected.
– Ask partners to get tested prior to unprotected oral sex.
– Limit sexual partners and avoid anonymous partners whenever possible.
– Seek immediate testing and treatment if you suspect exposure or notice any unusual mouth sores.
– Avoid all sexual contact while under treatment for syphilis until cured.
Taking precautions can help reduce the likelihood of contracting or spreading dangerous bacterial infections like syphilis.
Conclusion
Syphilis is a complex infection that can impact the mouth and oral cavity at every stage of progression. The characteristic sores, lesions and ulcers that develop on the lips, tongue and other mouth tissues make oral sex highly risky for syphilis transmission. Without prompt antibiotic treatment, syphilis bacteria will continue to spread and eventually advance to the tertiary stage where severe complications can develop. Practicing safe oral sex and getting regular syphilis testing are key to preventing disease transmission and allowing early intervention before major damage can occur.