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Primary syphilis - Oral Mucosal Lesion
See also in: Overview,Anogenital
Other Resources UpToDate PubMed

Primary syphilis - Oral Mucosal Lesion

See also in: Overview,Anogenital
Contributors: David O'Connell MD, Yun Xue MD, Susan Burgin MD
Other Resources UpToDate PubMed

Synopsis

Syphilis is a sexually transmitted disease (STD) caused by the spirochete bacterium Treponema pallidum. It is characterized by a chronic intermittent clinical course. Treponema pallidum is transmitted person to person via direct contact with a syphilis ulcer, saliva, or blood. It may enter through skin or mucous membranes. Hence, the locations for oral syphilitic ulcers include the lip, tongue, mucosa, and tonsils.

Chancres vary in size from a few millimeters to several centimeters. They have an incubation period of 10-90 days (average 21 days). The chancre lasts 3-6 weeks and heals spontaneously. All patients with primary syphilis will go on to develop secondary syphilis if the condition is left untreated. Secondary syphilis usually appears 3-10 weeks after the primary chancre and is characterized by a papulosquamous eruption and mucosal involvement, in some cases. Tertiary syphilis may appear months to years after secondary syphilis resolves and can involve the central nervous system (CNS), heart, bones, and skin.

Ocular screening (eg, slit lamp examination) is advised for patients with suspected or proven syphilis.

Immunocompromised Patient Considerations:
Ulcers caused by syphilis increase the risk of HIV transmission due to epithelial barrier compromise and increased numbers of macrophages and T-lymphocytes with HIV-specific receptors.

HIV infection can alter the clinical presentation of syphilis. Manifestations include multiple chancres, atypical cutaneous eruptions, increased severity of organ involvement (such as hepatitis and glomerulonephritis), and rapidly developing arteritis and neurosyphilis. Neurosyphilis can occur at any stage of syphilis.

Related topics: ocular syphilis, endemic syphilis

Codes

ICD10CM:
A51.0 – Primary genital syphilis

SNOMEDCT:
266127002 – Primary syphilis

Look For

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Diagnostic Pearls

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Differential Diagnosis & Pitfalls

All patients with an oral ulcer should have serologic testing for syphilis. The following differential will be focused on the chancre of primary syphilis.

Infectious:
Noninfectious:

Best Tests

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Management Pearls

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Therapy

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References

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Last Reviewed:08/25/2020
Last Updated:09/28/2020
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Primary syphilis - Oral Mucosal Lesion
See also in: Overview,Anogenital
Primary syphilis : Regional lymphadenopathy, Sexually active
Clinical image of Primary syphilis
A punched out ulcer with a raised border on the glans.
Copyright © 2021 VisualDx®. All rights reserved.