SINCE the advent of HIV, there has been a global tendency to de-emphasize the previous role of syphilis in the gamut of chronic diseases. Guyana is no exception. However, in recent times the relevance of this condition has reasserted itself so much that the government has been giving its prevalence a degree of priority.

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

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

Ten percent of 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 the 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 behaviours 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, the tip of the tongue, the tonsillar region, and 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 centimetres in diameter and have narrow, copper-coloured, slightly raised borders with a reddish-brown base (centre). The lesions are ulcerated over nearly their entire surface with a shiny base, 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 shapes.

Although various lesions may occur in different parts of the body during the tertiary stage of untreated syphilis, gumma develops in half of such cases. They are the most common syphilitic lesions seen in the oral cavity.