Oral forms of secondary syphilis: An illustration of the pitfalls set by the great imitator - 27/08/20

Doi : 10.1016/j.jaad.2020.04.089

Alexandre Lampros, MD ^a,^b, Vannina Seta, MD ^a, Phillippe Gerhardt, MD ^c, Camille Isnard, MD ^a, Corinne Husson, MD ^d, Nicolas Dupin, MD ^a,^c,^e,^f,^⁎
^a Service de Dermatologie, Hôpital Cochin, Assistance Publique des Hôpitaux, Paris, France
^b Sorbone University, Paris
^c CeGIDD, Hôpital Hôtel Dieu, Assistance Publique des Hôpitaux, Paris, France
^d Cabinet Médical, Paris, France
^e Centre National de Référence des infections sexuellement transmissibles, Laboratoire associé Syphilis, Paris, France
^f Institut Cochin, Inserm 1016, Université de Paris, Paris, France

^∗Correspondence to: Nicolas Dupin, MD, Service de Dermatologie et CeGIDD, Hôpital Cochin, site Tarnier, 89 Rue d'Assas 75006 Paris, France.Service de Dermatologie et CeGIDDHôpital Cochinsite Tarnier89 Rue d'AssasParis75006France

Sous presse. Épreuves corrigées par l'auteur. Disponible en ligne depuis le Thursday 27 August 2020
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Abstract

Introduction

Syphilis is reemerging in certain populations, such as in men who have sex with men in particular. Oral manifestations are not uncommon and can render diagnosis difficult, particularly if occurring in isolation.

Materials and methods

We recovered clinical data for all patients receiving a diagnosis of secondary syphilis who were referred to the National Reference Center for Syphilis in Paris, France, from January 2000 to July 2019. We selected patients presenting oral symptoms only and analyzed their general characteristics, time to diagnosis, and clinical presentations.

Results

Secondary syphilis was diagnosed in 206 patients, 38 of whom (18%) presented oral manifestations, which were isolated in 14 patients (37%). The main oral manifestations were subacute erosive or ulcerative lesions (55%), mucous patches on the tongue (53%), and nodular (10%) and leukokeratotic lesions (5%). Mean time to diagnosis was 4.5 months, but was significantly longer for patients with isolated oral symptoms (8.8 vs 1.8 months; P = .02).

Conclusion

Oral presentations of secondary syphilis are frequent and challenging for diagnosis, even in patients with epidemiologic risk factors. Clinicians confronted with subacute oral lesions in such patients should bear in mind the possibility of this contagious, curable, and sometimes severe disease.

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Key words : dermatology, men who have sex with men, oral mucosa, syphilis, Treponema pallidum