Etiology • Treponema pallidum spirochete
Clinical Presentation • Four clinical types (primary, secondary, and tertiary stages;
congenital form) plus neonatal form • Primary stage (oral)
• Initial sign usually a firm nodule/papule • Labial ulceration most common presentation • Ulcer firm, indurated, painless • Intraoral chancre is an ulcer covered by a pseudomembrane • Lesion is highly infectious • Regional cervical lymphadenopathy • Spontaneous resolution
• Secondary stage • Evolves after 6 weeks to 6 months if patient is untreated • Reddish brown macular rash periorally; generalized
cutaneous rash • Oral lesions are split papule at lip commissures, irregular
Clinical Presentation • Four clinical types (primary, secondary, and tertiary stages;
congenital form) plus neonatal form • Primary stage (oral)
• Initial sign usually a firm nodule/papule • Labial ulceration most common presentation • Ulcer firm, indurated, painless • Intraoral chancre is an ulcer covered by a pseudomembrane • Lesion is highly infectious • Regional cervical lymphadenopathy • Spontaneous resolution
• Secondary stage • Evolves after 6 weeks to 6 months if patient is untreated • Reddish brown macular rash periorally; generalized
cutaneous rash • Oral lesions are split papule at lip commissures, irregular
lesions, serpiginous ulcers, or erosions • Mucous patches orally (ulcers covered by mucoid exudate) • Lymphadenopathy • Highly infectious • Spontaneous resolution
• Tertiary stage • Develops over 3 to 10 years after primary infection if untreated
or inadequately treated (more rapidly in immunocompromised patients)
• Glossitis: atrophic, leukoplakia features • Gumma: destructive, painless, solitary granulomatous ulcer;
midline of tongue, palate, especially • Congenital form
• Hutchinson’s triad including mulberry molars, barrel-shaped incisors
Diagnosis • Clinical history, appearance • Direct smear in primary- and secondary-stage lesions (dark field)• Serologic studies (eg, VDRL [Venereal Disease Research Laboratories] test): positivity noted in last phase of primary stage
• Biopsy Differential Diagnosis
• Deep fungal infection • Traumatic ulcer • Squamous cell carcinoma • Leukoplakia • Midline granuloma/Wegener’s granulomatosis
Treatment • Antibiotics
• Parenteral penicillin (penicillin G benzathine) or ceftriaxone • Oral tetracycline or doxycycline
Prognosis • Excellent in primary and secondary stages • Fair in late (tertiary) phase