Dr. BERTRAND R. STUART DDS.
On some occasions, patients attend the dental clinic with signs and symptoms depicting the oral phenomenon of an STD (sexually transmitted disease). While gonorrhea of the throat is sometimes encountered, syphilis is seen more often. It is well established that HIV infection is linked to syphilis as well as tuberculosis. Our experience shows that at no time did any of these patients have a prior knowledge of the actual cause of their condition.

Syphilis is a venereal disease (sexually transmitted) caused by a spiral shaped germ that can move about like a tadpole. Someone can either acquire the disease or be born with it. The untreated acquired form has three easily recognizable stages:
1. The primary lesion called the chancre ‘sore’ is usually solitary.
2. The secondary lesions are numerous reddish patches or modules.
3. The tertiary lesion called gumma (similar to chancre) is found in the mouth.

Ten percent of the syphilitic patients manifest ulcers on the lining of the mouth. These correspond to the site of inoculation where there is a defect in the surface continuity of the skin or mucosa lining. The germs are transferred by direct contact with primary or secondary lesions of an infected individual. The chancres develop about three weeks after inoculation and persist for three weeks or two months.

Syphilis increases the risk of both transmitting and getting infected with HIV by up to five times. Having HIV at the same time can change the symptoms and course of syphilis. In addition, syphilis is an important predictor for becoming HIV infected because it is a marker for behaviors associated with HIV transmission.
While chancres on the genitals are characteristically painless, oral lesions become painful soon after they ulcerate because of the contamination by the oral

fluids and naturally occurring bacteria. Also, certain areas of the person’s neck usually become tender and painful to touch.
The primary lesions occur most often on the lips, tip of the tongue, in the tonsillar region and on the gum. They start as small red boils which get bigger and eventually ulcerate. The fluid coming from these nodules is extremely infectious and at this point the disease can easily be transmitted to another person through the so-called French kiss.

Mature chancres measure from 0.5 to 2 centimeters in diameter and have narrow, copper colored, slightly raised borders with a reddish-brown base (center). The lesions are ulcerated over nearly their entire surface with a base that is shiny and usually clear of rotted material and debris. Chancres occurring on the border of the lips are usually crusted. When it is initiated during the primary stage of the disease, penicillin injections over a period of seven days will successfully eliminate syphilis in the vast majority of cases.

The multiple secondary lesions of syphilis appear five to six weeks after the disappearance of the chancres and undergo spontaneous remission within a few weeks, but recurrences may be manifested periodically for months or even years. Sometimes the disease involves the brain causing madness and death. Children who were born with syphilis develop teeth with jagged edges and have some pointed shape.
Although a variety of lesions may occur in different parts of the body during the tertiary stage of untreated syphilis, gumma develops in half such cases. They are most common syphilitic lesions seen in the oral cavity.