Common syphilis in a child's mouth. Syphilis in the mouth - photo with a description of the characteristic symptoms. Treatment of the disease and possible complications

Syphilis in the mouth is a common disease of the modern generation, which ignores the rules of healthy sexual contacts and regular medical examinations. In some cases, it is enough to simply use an object from an infected person - a toothbrush, fork, toothpick, etc. Unfortunately, the disease is treated only in the early stages, which are not always diagnosed in a timely manner.

In this article we will look at the causes of Treponema infection, the main symptoms at each stage of the disease and methods of effective therapy.

Many patients do not have a single example of syphilis infection in their lives. And, nevertheless, this does not make the disease more rare or less dangerous, since absolutely anyone at any age and place can become infected with it.

In the mouth, the disease can manifest itself for several reasons.

Stages of the disease and characteristic symptoms

Many patients are interested in what syphilis looks like in the mouth (photo below). Just like a regular one, it goes through 3 stages and has characteristic visual manifestations. The first phase is characterized by the appearance of a specific hard chancre (painless ulcers), in the second phase they disappear and are replaced by roseola (a rash on the mucous membrane), and finally in the third phase a gumma (nodule) appears, changing the structure of soft tissues and even bones.

Let's look at each stage in more detail.

First phase

In the photo there are syphilitic chancres

The first phase is when chancre develops. In the area where the pathogen has entered the oral cavity, a round, reddish and fairly hard ulcer appears, which does not cause discomfort to the patient. Chancre can appear in any area of ​​penetration of triponema - the inside of the cheeks or lips, tongue, palate, tonsils and even gums. The diameter of the ulcer does not exceed 20 mm, and the edges are slightly higher than the center. In some cases, not one, but several adjacent chancre appears.

If we are talking about syphilis of the tongue, then the chancre may resemble a deep groove hidden in a fold of the mucous membrane.

The patient’s subjective sensations at this stage: compaction in the oral cavity of unknown origin, enlargement of nearby lymph nodes.

Second phase

The second phase is the attachment of papules, stomatitis and other formations. At the second stage, the chancre disappears, and is replaced by various rashes on the body and mucous surface. After 7-9 days, reddish roseolas form in the oral cavity, which unite into affected areas and increase in size. As a rule, this process develops into acute diffuse stomatitis.

Roseolas do not cause discomfort to the patient, so they are also difficult to notice in a timely manner.

The spots are located on the palate and tongue, the inner edging of the lips. They contain a high concentration of the pathogen inside. If you do not start taking antibiotics during this period, then the process of relapse begins. The spots either disappear or reappear, but in the form of papules and plaques.

Papules, unlike roseolas, are not symmetrically located in the mouth, forming so-called “patterns”. If you try to remove their top layer, peeling begins at the edges. If located on the tongue, the receptors and papillae in the area atrophy.

The photo shows the manifestations of secondary syphilis on the lips

In some cases, purulent abscesses (pustules) may also appear at the second stage. This process is accompanied by a sharp swelling of the lymph nodes of the whole body and hyperthermia.

Stage 2 symptoms are highly contagious, since the formations contain a high density of triponema. During this period, the patient should be immediately admitted to a hospital and isolated from others.

If effective therapy is not started in the second phase, the pathogens will invade the larynx and pharynx, which will cause syphilis of the throat.

Third phase

The third phase – the appearance of gummas, glossitis. The disease in this phase is quite advanced, so new formations are added to the papules - nodules (gummas), abscesses and bumps. This process can take about 4-5 months.

At the beginning of the phase, the nodes are compactions on the tongue or palate, after the disappearance of which voluminous ulcers remain. When the wound heals, an atrophic scar remains in its place, which severely deforms the soft tissues and even the jaw bones. In rare cases, a canal appears between the nose and mouth or the mouth and sinuses.

During this period, the patient cannot speak clearly. Oral syphilis is accompanied by diffuse glossitis, which provokes the development of connective tissue. The tissue of the tongue thickens, making it almost immobile, interfering with eating and communication.

Pathologies that develop in the third phase cannot be treated or naturally restored. In most cases, the patient is prescribed therapeutic plastic surgery or prosthetics.

Diagnosis of the disease

An initial examination and identification of formations may indicate the possibility of infection of the patient with syphilis. Inflamed areas, roseola, spots, chancre have clearly defined boundaries. When diagnosing such formations, the doctor must refer the patient to a dermatovenerologist, who, in turn, will send the discharge from the cavities for examination. The study is carried out under a microscope, which reveals the content of tryponema in the pathological fluid.

Unfortunately, positive confirmation can only be obtained 2-3 weeks after the appearance of the primary foci of inflammation. Also, discharge from chancre may not contain the pathogen, so the venereologist will try to find them in the lymph nodes.

Positive confirmation of syphilis can be obtained only 2-3 weeks after the appearance of primary foci of inflammation

Serological tests and procedures detect oral syphilis at any stage. The Wasserman reaction reveals an increase in the amount of antibodies. However, the method does not always provide reliable information, since pregnant women and people with autoimmune diseases may have a false positive reaction.

An effective method for detecting the disease can be immunodiagnosis, analysis of punctate from spinal cord fluid, or a blood test for syphilis. The latter is prescribed to people at risk (health workers, vulnerable groups of the population, pregnant women, workers in child care institutions and catering, donors).

The analysis is also mandatory for people who are sexually active and engage in oral and homosexual acts.

Treatment of the disease and possible complications

Therapy in this case is aimed at suppressing the vital activity of triponema. Effective symptomatic treatment is also required, and the sooner, the safer for the patient (lower the risk of complications and relapses).

As a rule, the doctor prescribes bactericidal medications various groups and forms, as well as immunostimulants. Treatment is carried out in several courses, between which long pauses should be maintained.

Symptomatic treatment involves taking antipyretic drugs, using local wound-healing and tissue-regenerating agents, applications, baths, rinses, etc.

At the end of the course of treatment, the doctor carries out serological blood monitoring for several months.

If therapy is not prescribed in a timely manner, the disease will affect not only the soft tissues of the oral cavity, but also internal organs and systems, which will lead to a general deterioration of the patient’s condition.

With each passing month, the symptoms of syphilis on the tongue (photo below) and other areas of the oral cavity will fade, which patients mistakenly attribute to improvement.

Syphilis on the tongue

However, after some time serious complications should be expected:

• necrosis of soft tissues in the area of ​​infection;
• damage not only to the mucous membrane, but also to internal organs and bones;
• disruption of the circulatory and vascular systems, the occurrence of local bleeding;
• damage to the soft tissues of the face and neck, asymmetry of facial contours;
• slow destruction of brain cells.

Remember that a complete cure in stages 2 and 3 is almost impossible. Visit your dentist regularly, get tested, do a weekly self-exam of your mouth, and avoid indiscriminate sexual contact. It is also important to know that the body does not develop immunity to syphilis, which means that re-infection is possible.

Sexually transmitted diseases do not always affect the surface of the genitals - sometimes clinical manifestations are diagnosed in the oral cavity. Treponema pallidum, after attaching to the surface of the mucous membrane, causes syphilis in the mouth to develop rapidly.

Despite the local damage, the threat to health is high to the same extent as when a rash occurs in the groin area.

Features of infection

Damage to the oral cavity occurs after unprotected oral contact with a partner who is a carrier of a sexually transmitted infection. There is a high risk of transmitting the pathogen through a kiss, as well as sharing utensils.

The appearance of an insidious disease is acceptable even after a visit to a medical institution where sanitary standards for disinfecting instruments are violated.

Methods of transmission of Treponema pallidum:

• visiting a dentist's office;
• examination by an otolaryngologist;
• treatment of patients with venereal disease;
• opening of the abscess.

Syphilis appears on the tongue and other parts of the mouth also probably after injections, blood transfusions and surgery in this area. During the incubation period, the patient feels depressed, weak, and experiences a relapse of chronic diseases.

Primary stage

As with damage to the genital organs, the development of the disease includes 3 stages. The first stage is characterized by a long wait for the first signs to appear, which develop a month after Treponema pallidum attaches to the body. In the second month (in 95% of those infected), although already after 1 week it is observed - a sign that is rarely given special significance.

However, gross pathological changes are more often diagnosed, leading to lymphadenitis, in which red swelling bumps form in places where the lymphatic system is localized (usually in the cervical, occipital and ear regions).

Clinical manifestations:

• the presence of 1 or more chancre;
• frequent projection - on the lips, tonsils and tongue;
• rare location - on the gum;
• sizes - from 5 to 20 mm;
• no ulcer pain.

The chancre is red in color, has hard edges and a soft center that often dies. If the treponema is attached to the wound located at the entrance to the mouth, then syphilis on the lips is diagnosed, which differs from colds on the lips in the absence of small blisters with wet contents, as well as a dense crust.

From purulent tonsillitis, the lesion is differentiated by the side of the lesion - with a sexually transmitted disease, only one side of the tonsil is damaged. Another important marker is the appearance and development of an ulcer, which on the tonsils often turns white rather than red. It does not cause pain, but during the period of enlargement itching may occur. The development of pain syndrome is observed only after the disease progresses.

Difference from other types of rashes: chancre has a round shape. Occasionally it takes the form of a groove hidden in the lingual fold.

Secondary stage

Protected sexual contacts and visits to medical organizations with a high reputation, which guarantee protection against household transmission of treponema pallidum, remain effective ways to prevent infection.

this is a serious disease caused by the bacterium Treponema pallidum(treponema pallidum). The disease is a sexually transmitted infection, so the attitude towards syphilitics is usually sharply negative. However, to become infected with syphilis, you do not have to lead a wild lifestyle.

Routes of infection

Treponema pallidum enters the human body as follows:

• sexually;
• in utero;
• through non-sterile medical instruments in dentistry;
• household method: through toothbrushes and other personal hygiene products;
• through wounds on the oral mucosa.

The first variant of syphilitic infection is the most common. Moreover, the causative agent of the disease can enter the body even through a kiss, especially if there are cuts or ulcers on the oral mucosa.

Syphilis can be congenital. The baby becomes infected with it from the mother during intrauterine development. With timely medical intervention and full medical monitoring of the progress of pregnancy, intrauterine infection with a syphilitic infection can be avoided.

Syphilitic infection can be contracted during dental treatment or surgery. In this case, Treponema pallidum enters the body through poorly processed medical instruments.

Doctors are a particular risk group for contracting sexually transmitted infections. The causative agent of syphilis on the tongue can enter their body if basic precautions are not observed during the examination and treatment of the patient’s teeth and oral mucosa.

Stages, signs and symptoms of syphilis in the mouth

There are three main stages of syphilitic infection. The first one is easy to treat, but it is quite difficult to detect it in time. The last two stages of the disease usually occur in a chronic form and can cause irreparable harm to the body. Complete healing in the final stages of the disease is impossible.

In addition to the three main stages of the infectious process, there is an incubation period. At this time, the patient does not yet show symptoms of syphilis in the mouth.

Incubation period

The incubation period lasts 2–3 weeks from the moment of infection with a syphilitic infection. Many people attribute this period of development of the disease to primary syphilis, but since it is almost impossible to detect the disease during the specified period, experts distinguish it into a separate stage.

The incubation period for oral syphilis may be longer if:

• the patient takes antibiotics for other diseases: colds, flu;
• The infected person has good immunity, capable of fighting the pathogen for a long time.

In women, visible signs of syphilis in the mouth usually appear later than in men, since the incubation period of the disease lasts longer for them.

Primary stage

The main manifestation of the primary stage of syphilitic infection is the formation of a hard chancre on the tongue, palate or lip. If infection occurs through a damaged mucous membrane of the oral cavity, then a seal forms exactly in the place where the wound is located. At first, chancre looks like normal redness.

The affected area gradually grows and can reach several centimeters in diameter. Erosion appears in the center of the lesion, having a bright red tint. Until this moment, chancre does not cause the patient any discomfort, so it is difficult to detect it at the first stage of the disease.

Chancre in the mouth is far from the only symptom of a sexually transmitted disease. The disease may be accompanied by inflammation of the lymph nodes. This means that the syphilitic infection has reached them. In turn, such a lesion leads to general malaise, weakness, and pain reactions.

Secondary stage

If treatment is not started within two months after contracting syphilis, the disease will develop into a secondary form. At this stage of sexually transmitted infection, formations in the form of roseola and papules appear in the oral cavity.

Papules are rashes that are round in shape, but without clear outlines. They can appear on the tongue, palate, throat and tonsils. Ulcers can form in one place and thereby form large lesions. If a papule appears on the tongue, the sensitive papillae atrophy in this area, a plaque appears, under the surface of which inflamed red tissue is hidden.

Roseolas look a little like papules. They are spots that most often appear near the teeth, on the palate and tonsils. Due to their bright red color, roseolas stand out against the background of the oral mucosa. They do not cause the patient much discomfort, so until papules appear, a person may not even be aware of a syphilitic infection.

Photo: this is what secondary syphilis looks like in the mouth

In addition to the appearance of roseola and papules, the secondary stage of syphilis on the tongue is distinguished by the following:

• it is most contagious to others;
• the rash appears not only in the mouth, ulcerative lesions spread to the skin of the body and face;
• the infection affects internal organs, so a general deterioration in health is possible.

If the second stage of syphilitic infection is detected, the patient is immediately isolated. All his relatives must be tested for the presence of Treponema pallidum in their bodies.

Tertiary stage

The tertiary stage of syphilis in the oral cavity is characterized by the most striking manifestations: lumpy rashes or gummas appear on the gums near the teeth, on the tongue and palate. The last stage of development of the disease begins only 3–4 months after infection and only in the complete absence of treatment. It is impossible to get rid of an advanced sexually transmitted infection without consequences.

Tertiary syphilis begins painlessly and even unnoticeably. A node (gumma) appears on the oral mucosa. Such formations can be everywhere, but most often they are located on the tongue, lip or palate.

The node gradually increases in size, becomes painful and acquires a brown tint. The tissue in the middle of the gumma dies and an open ulcer forms. The dense tissue around the ulcer rises above the level of the mucous membrane of the affected area of ​​the oral cavity.

With proper treatment, the healing process of soft tissues of the oral cavity affected by tertiary syphilis takes from 3 months to six months. A noticeable scar remains in place of the gumma. If the formation has managed to destroy a large area of ​​soft tissue of the tongue, palate or lip, plastic surgery may be required.

Lumpy syphilitic rashes often appear on the lips. They are localized in groups and at first do not cause much discomfort. As the bumps grow, they gradually turn into small open wounds. When the ulcers that appear in the mouth due to tertiary syphilis heal, they leave permanent scars.

Consequences of the disease

Syphilis is a dangerous disease that can lead to serious consequences. Among them:

• Extensive damage to the soft and hard tissues of the oral cavity.
• Dead areas of soft tissue in the mouth and noticeable scars in the area of ​​chancre, papules and nodes.
• Disturbances in the functioning of the cardiovascular system.
• Damage to the muscles of the face and neck.
• Facial asymmetry.

Without treatment, syphilis spreads to adjacent tissues. The disease can even affect the brain, which can have serious consequences, including death.

Diagnosis of the disease

A dermatovenerologist is involved in identifying and treating syphilitic infectious diseases. In the second and third stages, the disease is easily identified by external signs. An experienced specialist will accurately distinguish a hard chancre or papule on the lip, palate, gum and other parts of the oral cavity from formations that look similar. Initial syphilis can only be detected through a blood test.

Since syphilis can be completely cured only if therapy is started within the first months after infection, tests to identify this sexually transmitted disease are taken during any comprehensive examination.

Features of treatment

The main goal of therapy for syphilis in the oral cavity is to suppress the pathogen. For this, the patient is prescribed a number of medications with an antibacterial effect. To improve the effect of basic medications, it is necessary to take drugs that normalize the functioning of the immune system.

Since secondary and tertiary syphilis manifests external symptoms - papules, ulcers, gummas, the patient is prescribed drugs that improve tissue regeneration. If there are chancres, roseolas or papules on the patient’s tongue, ointments are prescribed to heal them. Usually preference is given to those drugs that have a healing, antiseptic and analgesic effect.

When treating the tertiary stage of the disease, in addition to drug therapy, surgery may be required. The patient either has the affected tissue restored or the scars that interfere with a full life are removed.

In addition, treatment in the final stages of sexually transmitted infection differs in the following:

• It is no longer possible to completely get rid of syphilis in the oral cavity. You will have to visit a specialist at least once every six months to check your health.
• Even if the disease is in an inactive stage, the patient may remain a carrier. Therefore, additional precautions need to be taken.

A person who has had syphilis must constantly monitor their health. It is better to get rid of all bad habits, start eating right and exercising. All this is necessary to improve immunity and prevent relapses of the disease.

Syphilis in the mouth and throat occurs during all periods of the disease. The microflora of the oral cavity affects syphilides, and therefore the classic picture of the disease often changes. (the causative agents of syphilis) affect the lymphoid tissue of the larynx and pharynx, which leads to attacks of uncontrollable coughing. The cervical, submandibular, pretracheal and occipital lymph nodes are enlarged.

Syphilis in the mouth and throat (larynx and pharynx) occurs without severe pain and inflammation. The disease lasts a long time, and resistance to specific therapy is often noted. Serological tests in most patients give positive results.

Rice. 1. Damage to the hard palate in secondary syphilis - papular syphilide (photo on the left) and the consequences of tertiary syphilis - perforation of the hard palate (photo on the right).

Manifestations of syphilis in the mouth during the primary period of the disease

With primary syphilis, ulcers appear at the site of pathogen penetration - hard chancre (hard ulcers, primary syphilomas). The reason for their occurrence in the mouth is the transmission of infection through sexual perversion, less often - kissing a patient, using infected dishes and personal hygiene items, wind instruments and smoking pipes. Hard chancroid can appear on the mucous membrane of the lips, tongue and tonsil, less often on the gums, mucous membrane of the hard and soft palate, pharynx and larynx.

Hard chancre (primary syphiloma) forms 3 to 4 weeks after the initial infection. Its size is 1 - 2 cm in diameter. There is no pain or other subjective manifestations of the disease. Single erosive chancres are more common. They have a smooth shiny surface, bright red color, round or oval shape. The compaction at the base is less pronounced.

Hard ulcerative chancres are more common in individuals with severe concomitant diseases and reduced immunity. They have a deep defect in the center - an ulcer and pronounced compaction at the base. The bottom of such an ulcer is covered with a dirty yellow coating, and there is copious discharge. Often small hemorrhages form at the bottom.

Rice. 2. In the photo there is syphilis of the tongue in the primary period of the disease - chancre on its lateral surface.

Manifestations of syphilis in the mouth in the secondary period of the disease

During the period of generalization of the infectious process, secondary syphilides appear on the mucous membranes of the oral cavity - rashes in the form of roseola and papules. The mucous membrane of the tongue, cheeks, soft palate, palatine arches, tonsils are the main places of their localization.

Syphilitic roseola in the oral cavity is localized on the tonsils and soft palate and is a bright red spot. When roseola merge, large areas of hyperemia are formed, sharply delimited from the surrounding tissues. The general health of the patients remains satisfactory.

Papular syphilides in the oral cavity (dense elements) have a round shape and dough-like consistency, they have a dense base and clear boundaries, they are bright red in color, painless. Constant irritation leads to the appearance of erosion papules on the surface. Papules are most often located on the mucous membrane of the gums, cheeks, along the edges and on the tip of the tongue, in the corners of the mouth, less often - on the mucous membrane of the nose, pharynx, hard palate, vocal cords, epiglottis and eyes.

• Erosive-ulcerative syphilides often appear on the soft palate and tonsils.
• Papules located in the corners of the mouth resemble jams.
• Papules located on the back of the tongue look like bright red, oval-shaped formations with a smooth surface - devoid of papillae (“mown meadow symptom”).
• Papules localized on the vocal cords lead to hoarseness and even complete loss of voice.
• Papular syphilide of the nasal mucosa occurs as a type of severe catarrhal inflammation.

Papules should be distinguished from bacterial tonsillitis, lichen planus, diphtheria, aphthous stomatitis, flat leukoplakia, etc.

Rashes in the oral cavity due to secondary syphilis are extremely contagious.

Pustular syphilide on the mucous membranes of the oral cavity is rare. The developed infiltrate disintegrates, forming a painful ulcer covered with pus. The general condition of the patient suffers.

Rice. 3. Syphilis in the mouth - papular syphilide of the hard palate.

Manifestations of syphilis in the mouth during the tertiary period of the disease

In 30% of cases, the mucous membranes of the nose, soft and hard palate, tongue and posterior pharyngeal wall are affected. Tertiary syphilides are always few in number, appear suddenly, there are no signs of acute inflammation and subjective sensations. There is often no response from the lymph nodes.

Gummous syphilide The mucous membrane appears in the form of a small node, which, due to sudden infiltration and edema, increases in size and acquires a dark red color. The boundaries of the gummous lesion are clear. Over time, the infiltrate disintegrates, soft tissue and bone formations are destroyed, which leads to irreversible deformations and impaired organ function.

The resulting ulcer is deep, has crater-shaped edges, congestive-red color, sharply demarcated from the surrounding tissues, painless, with granulations at the bottom. During healing, a retracted scar is formed.

• The disintegration of the gumma located on the hard palate leads to its perforation.
• The disintegration of the gumma located in the area of ​​the nasal septum leads to its deformation (“saddle nose”) and perforation of the nasal septum, the integrity of the organ and the function of breathing, swallowing and phonation are disrupted. The resulting perforations do not close during healing.

The rashes of the tertiary period of syphilis are practically not contagious, since they contain a minimal number of pathogens.

Tuberous syphilide occurs less frequently. The tubercles most often appear on the lips, soft palate and uvula (vera palatine), hard palate and the mucous membrane of the upper jaw that supports the teeth (alveolar process). The tubercles are dense to the touch, small, prone to grouping, reddish-brown in color, and quickly disintegrate with the formation of deep ulcers. Healing occurs in scars.

Rice. 4. The photo shows the consequences of tertiary syphilis in the mouth - perforation of the hard palate.

Syphilis on the tongue

The tongue with syphilis is affected in the primary, secondary and tertiary periods of the disease.

Syphilis of the tongue in the primary period of the disease

Hard chancre on the tongue is often single, ulcerative or erosive in nature. Sometimes it has a slit-like shape located along the tongue.

Rice. 5. Syphilis of the tongue in the primary period - chancre. Syphilide is an erosion or ulcer with a dense infiltrate at the base.

Rice. 6. The photo shows a hard chancre on the tip of the tongue.

Syphilis of the tongue in the secondary period of the disease

During the secondary period of syphilis, erosive papules most often appear on the mucous membrane of the tongue - papular syphilide.

Rice. 7. Papules on the tongue are oval in shape, bright red in color, painless and highly contagious.

Rice. 8. The photo shows syphilis of the tongue in the secondary period of the disease. The papules are round, dark pink, single or multiple, devoid of papillae (“mown meadow symptom”).

Rice. 9. Secondary period of syphilis. Papules on the tongue.

Syphilis of the tongue in the tertiary period of the disease

In the tertiary period of syphilis, single or multiple gummas (nodular glossitis) more often appear on the tongue, diffuse (spread) sclerosing glossitis develops less often. Sometimes, isolated gummas appear against the background of sclerosing glossitis.

Gummous infiltrate It is large in size (about the size of a walnut), quickly disintegrates with the formation of a deep ulcer and an uneven bottom, surrounded by a shaft of dense infiltrate. The developed scar tissue significantly deforms the tongue.

Sclerosing glossitis characterized by the development of diffuse infiltration in the thickness of the tongue. The tongue becomes dense, acquires a dark red color, and the mucous membrane thickens. As a result of rapidly developing sclerosis, when muscle fibers are replaced by dense connective tissue, the tongue contracts and becomes smaller in size, its surface is smoothed (loses papillae), becomes bumpy, and becomes significantly denser (“wooden” tongue). There is increased salivation (salivation). Appearing cracks often become infected, which leads to the appearance of erosions and ulcers that are prone to malignancy. The disease occurs with severe pain, the patient's speech is impaired and eating is difficult.

Rice. 10. Syphilis of the tongue in the tertiary (late) period of the disease - a single gumma of the tongue (photo on the left) and a disintegrating gumma (photo on the right).

Syphilis of the tonsils (syphilitic tonsillitis)

Treponema pallidums have a tropism for lymphoid tissue, which is why syphilitic tonsillitis and enlarged lymph nodes are recorded at all stages of the disease.

Syphilis of the tonsils in the primary period

During the period of primary syphilis, chancre is sometimes recorded on the tonsils. The disease occurs in several forms - anginal, erosive, ulcerative, pseudophlegmonous and gangrenous.

• In the anginal form of the disease, the primary chancre is often hidden in the submygdaloid sinus or behind the triangular fold. The patient's body temperature rises and moderate pain in the throat appears. The palatine tonsil is hyperemic and enlarged in size. Regional lymph nodes are enlarged.
• When an oval-shaped red erosion with rounded edges, covered with gray exudate, appears on the tonsil, they speak of an erosive form of tonsil chancre. The bottom of such erosion has a cartilaginous structure.
• In the ulcerative form, a round ulcer appears on the palatine tonsil. At its bottom there is a film that is gray in color (syphilitic diphtheroid). The disease occurs with high body temperature, sore throat radiating to the ear on the affected side, and increased salivation.
• The pseudophlegmonous form of the disease occurs as peritonsillar phlegmon. Massive doses of antibacterial drugs significantly improve the patient’s condition, but the syphilitic process continues.
• In the case of the addition of a fusospirile infection, a gangrenous form develops. The disease is characterized by the development of a septic process and gangrene of the tonsil.

A long course and lack of effect from symptomatic treatment are characteristic signs of primary syphilis of the tonsils - chancre-amygdalitis.

Rice. 11. In the photo there is syphilis of the tonsils - chancre-amygdalitis, ulcerative form.

Rice. 12. In the photo, the anginal form of the disease is chancre-amygdalitis of the right tonsil. A characteristic feature is the characteristic copper-red color of the tonsil and the absence of inflammation of the surrounding tissues.

Syphilitic tonsillitis of the secondary period of the disease

With secondary syphilis, secondary syphilides - roseola and papules - may appear on the soft palate, tonsils and arches.

• Roseola (spots of hyperemia) during the disease are located either isolated or can merge and form large areas of hyperemia. The defeat is called erythematous syphilitic sore throat. Roseolas are red in color and sharply demarcated from surrounding tissues. The patient's condition remains satisfactory.
• When papules appear on the tonsils and the area of ​​the lymphoid ring, they speak of papular syphilitic sore throat. Papules merge to form plaques. The rashes have clear boundaries. With constant irritation, the papules become ulcerated and covered with a whitish coating, pain appears when swallowing, the temperature rises, and the general condition of the patient worsens.

Rice. 13. In the photo there is syphilis in the mouth. On the left is syphilitic erythematous tonsillitis, on the right is papular tonsillitis.

Rice. 14. The photo shows erythematous syphilitic tonsillitis.

Syphilis of the tonsils in the tertiary period of syphilis

In the tertiary period of syphilis, gumma may appear on the tonsil. The disintegration of gumma leads to complete destruction of the organ and surrounding tissues. Cicatricial deformation of the pharynx leads to the development of severe atrophic pharyngitis.

Syphilis of the hard palate

With primary, secondary and tertiary syphilis, the hard palate can be affected. Gummas of the hard palate can affect not only the mucous membrane, but also spread to the bone structures of the organ, which leads to their destruction and perforation.

Syphilis of the hard palate in the primary period of the disease

Primary syphiloma (chancroid) on the hard palate appears 3 to 4 weeks after infection. With ulcerative chancre, a hard infiltrate is located at the base. In the case of the formation of a deep ulcer, the infiltrate at the base acquires a cartilage-like structure. With erosive chancre, the infiltrate at the base is barely noticeable and weakly expressed. Even without treatment, after 4 to 8 weeks, the ulcer and erosion scars on its own. Scarring occurs much faster under the influence of specific treatment.

Rice. 15. Syphilis in the mouth. Primary syphiloma of the hard palate.

Syphilis of the hard palate in the secondary period of the disease

With secondary syphilis, papular syphilides more often appear on the mucous membrane of the hard palate. They are dense, flat, round, smooth, red, located on a dense base, with clear boundaries, painless. Frequent irritation leads to the appearance of areas of maceration on the surface, and sometimes papillary growths. As papules grow, they merge.

Rice. 16. Syphilis in the mouth - papules on the hard palate and tongue (photo on the left) and papules on the hard palate (photo on the right).

Syphilis of the hard palate in the tertiary period of the disease

When gumma is located on the hard palate, the disease is tragic. Due to the thin mucous membrane, the gummous process quickly spreads to the periosteum and bone. When gumma disintegrates, the bone quickly becomes necrotic and sequestra (dead areas) appear. As a result of the perforation, a communication occurs between the nasal cavity and the mouth, which leads to difficulty eating and speech impairment.

Rice. 17. Gummous infiltration of the hard palate (photo on the left) and gummous infiltration (photo on the right).

Rice. 18. The photo shows the consequences of tertiary syphilis - perforation of the hard palate.

Syphilis of the soft palate

The soft palate (vera palatine) is often affected along with the hard palate in tertiary syphilis. Gummas may appear on it, but gummatous infiltration occurs more often. The affected areas have a rich purple color and lead to stiffness of the soft palate. As a result of cicatricial changes, atresia (fusion) of the pharynx occurs. The soft palate fuses to the back of the oropharynx, causing the oral and nasal cavities to separate. Organ function is impaired.

With the development of tubercular syphilide, isolated elements are formed on the soft palate, the breakdown of which forms ulcers that heal with scars. Scar tissue leads to deformation of the organ.

Rice. 19. Damage to the soft palate (schematic representation).

Syphilis of the throat: damage to the pharynx

The pharynx is the initial part of the digestive tract and respiratory tract. It connects the nasal cavity and the larynx, the vocal organ.

Damage to the pharynx in primary syphilis

With primary syphilis, unilateral lesions are more often observed. Chancre can be erythematous, erosive or ulcerative. Treponema pallidum has a tropism for lymphoid formations of the throat. Their defeat leads to the appearance of an indomitable cough. With the disease, regional lymph nodes always enlarge.

Damage to the pharynx with secondary syphilis

The pharynx in secondary syphilis is often affected along with the larynx. At the same time, skin rashes appear on the patient’s skin—secondary syphilides.

Damage to the pharynx in tertiary syphilis

In tertiary syphilis, damage to the pharynx occurs in the gummous form, diffuse and early ulcerative-serpentiform forms.

• The gummous infiltrate does not manifest itself in anything until ulceration appears. When gumma disintegrates, bleeding may occur and the bones of the spine and skull may be destroyed. As a result of the development of scar tissue, communication (partially or completely) between the nasal and oral cavities is disrupted. Breathing becomes possible only through the mouth, the voice changes, taste and smell disappear.
• In the diffuse syphilomatous form, multiple lesions are observed on the mucous membrane of the pharynx. At the beginning of the disease, the changes are in the nature of hypertrophic pharyngitis. But then an extensive syphilitic ulcer is formed, similar to carcinoma.

Syphilis of the throat: damage to the larynx

The larynx is the upper part of the respiratory system and the organ of voice production. It is located in the front of the neck, where the Adam's apple (thyroid cartilage) is formed.

Damage to the larynx in secondary syphilis

With secondary syphilis, the appearance of roseola or papular rashes on the vocal cords is noted, which leads to syphilitic dysphonia (violation of the sound of the voice) or aphonia (complete absence of voice). Diffuse erythema is similar to catarrhal laryngitis. Since secondary syphilides in the larynx do not show themselves for a long time, the disease goes unnoticed at first, and the patient all this time poses a danger to others.

Damage to the larynx in tertiary syphilis

• During the period of tertiary syphilis, gummas may appear in the larynx. When they disintegrate and a secondary infection attaches, inflammatory edema appears, which leads to difficulty breathing. The ulcer, when the gumma disintegrates, has crater-shaped, sharply defined edges, is dense, with a greasy bottom. When the gumma is located on the epiglottis, the presence of a foreign object in the throat is felt. With large infiltrate sizes, laryngeal stenosis develops. Scarring of syphilitic ulcers located on the vocal folds and when the arytenoid cartilages are damaged, the voice becomes hoarse forever, sometimes aphonia develops (complete loss of sonority of the voice). Soreness is often absent or insignificant.
• With the development of a diffuse gummous infiltrate, the lesion affects the superficial layers of the organ, sometimes deep, when the pathological process passes to the muscle layer and perichondrium. The site of infiltration has the appearance of reddish-yellow thickenings with an inflammatory rim along the periphery, often extending to the epiglottis, or ligamentous apparatus, or subglottic region. With ulceration, the surface of the diffuse gummous infiltrate becomes uneven.

Syphilitic perichondritis

If gummous infiltration reaches the perichondrium, syphilitic perichondritis develops. Damage to the epiglottis leads to complete loss of its substance at the free edge. However, despite this, swallowing occurs unhindered. The affected arytenoid cartilages swell. With inflammation of the cricoid cartilage, swelling is localized below the vocal cords, and pain appears when swallowing. When the thyroid cartilage is damaged, the vestibular vocal folds thicken. Increasing stenosis with perichondritis sometimes requires tracheostomy.

A defect of the epiglottis, complete immobility of the crico-arytenoid joints, rough, radiant whitish scars tightening the entrance to the larynx are the consequences of perichondritis. Such patients must constantly wear and breathe through special tracheotomy tubes.

Rice. 20. The photo shows cicatricial stenosis of the larynx.

– a chronic infectious disease caused by Treponema pallidum. With the primary lesion, a hard chancre forms on the mucous membrane - an infiltrate with a decay area in the center of a red color of a regular round shape. There are no complaints of pain. Secondary syphilis of the oral cavity is characterized by the appearance of multiple rashes of a roseolous-papular nature. The presence of gummous infiltrate indicates tertiary syphilis of the oral cavity. Diagnosis of the disease includes clinical examination, bacterioscopy of scrapings, serological reactions, and radiography. Treatment of oral syphilis is carried out in a skin and venereal disease clinic.

General information

Oral syphilis is a specific infectious disease that occurs as a result of the penetration of Treponema pallidum into the body. Most patients diagnosed with syphilis show characteristic signs of damage to the oral mucosa, periosteum or bone tissue of the upper and lower jaws. Often the primary syphilitic lesions are localized in the oral cavity. With primary syphilis of the oral cavity, 1 chancre is found in 95% of patients. It is extremely rare for several syphilomas to form. During the tertiary period, gummous infiltrates that destroy bone tissue are more often detected on the lower jaw. In children and adolescents, the main routes of infection are intrauterine and domestic, while in older people, in most cases, infection with oral syphilis occurs as a result of unprotected sexual intercourse.

Causes and classification of oral syphilis

Oral syphilis develops as a result of infection with Treponema pallidum. The main routes of transmission of the disease are intrauterine, domestic, and sexual. Predisposing conditions that open the gates for the introduction of anaerobes are skin cracks and erosions of the oral mucosa. A hard chancre is formed at the site of spirochete penetration. Reproduction of bacteria in oral syphilis occurs in the lymph nodes, as a result of which polyadenitis is observed just a few days after infection. In response to the penetration of Treponema pallidum into the body, the human immune system produces antibodies aimed at binding and eliminating infectious agents. Further spread of bacteria in the human body occurs through the vessels of the lymphatic system.

Oral syphilis goes through 4 periods:

1. Incubation. It is characterized by the absence of a specific clinic and lasts for 3-5 weeks from the moment of infection.

2. Primary syphilis of the oral cavity. It occurs with the appearance of primary syphiloma in the oral cavity and lasts for 6-8 weeks. The first 3 weeks are seronegative, since specific serological tests cannot isolate Treponema pallidum. The next 3 weeks are considered the seropositive period.

3. Secondary syphilis of the oral cavity. Followed up for 4 years. The mucous membranes, skin, and internal organs are affected. Secondary syphilis of the oral cavity begins with a phase of pronounced clinical manifestations lasting about 3 weeks. In this case, multiple foci of roseolous-papular rash appear on the oral mucosa, and polyadenitis is observed. The disease then enters the latent stage. Alternation of exacerbations and remissions can occur up to 3-4 times. Serological reactions are positive.

4. Tertiary syphilis of the oral cavity. Lasts for 6-8 years. The main element of the lesion is gummous infiltrate. The number of pale treponema is significantly reduced. Serological reactions are positive in 70% of cases. Tertiary syphilis leads to irreversible destructive changes in organs and systems and causes progressive paralysis.

Symptoms of oral syphilis

The clinical picture of the disease directly depends on the stage of the pathological process. Primary syphilis of the oral cavity is indicated by the appearance of an infiltrate, in the center of which a decay zone is formed. The edges of the primary element of the lesion are regular, smooth, the bottom is red, infiltrated. On examination, syphiloma is painless and rises slightly above the mucous membrane. Due to the activation of anaerobic microflora, the bottom of the ulcer becomes covered with a dark gray coating. More often, hard chancre is localized on the lips, tongue, palate, and tonsils. A few days after the appearance of syphiloma, lymphadenitis is observed, accompanied by hyperthermia, lethargy, and deterioration of the general condition.

Secondary syphilis of the oral cavity is characterized by the occurrence of syphilitic sore throat and multiple roseolous-papular elements of the lesion. Roseola are hyperemic areas of the mucosa with clear contours. Papules are foci of discolored mucous membrane (usually bluish-red) with a slight elevation in the center. The favorite localization of morphological elements in secondary syphilis of the oral cavity is the distal areas (palate, tonsils). Papules and roseolas tend to merge, resulting in a clinical picture that resembles a sore throat. Syphilitic lesions of the tongue manifest themselves in the form of atrophy of the filiform and circumvallate papillae. In this case, the back of the tongue takes on the appearance of a “mowed meadow” - normal areas of the mucous membrane alternate with pathologically altered areas.

With tertiary syphilis of the oral cavity, a gummous infiltrate is formed. The pathological process can affect the tongue, which leads to its thickening, scarring, and permanent deformation. When the periosteum is involved in the inflammatory process, a compaction of the periosteum occurs, adhering to the mucosa. In the case of localization of a syphilitic lesion in the area of ​​the alveolar process, pathological mobility of the teeth is observed, the vertical percussion of which becomes positive. When the infiltrate breaks through, a painless, crater-shaped ulcerative surface with smooth edges is formed. The formation and rejection of sequestra in oral syphilis is rare. Over time, the affected area becomes scarred. As a result of the formation of gumma on the upper jaw, an anastomosis of the oral cavity with the nasal cavity may occur. With tertiary syphilis of the oral cavity, the integrity of the bones of the nose and nasal septum is compromised.

Diagnosis of oral syphilis

The diagnosis of “oral syphilis” is based on the patient’s complaints, medical history, clinical examination, and the results of additional research methods. With primary syphilis of the oral cavity, the dentist usually identifies one hard chancre. On palpation, the resulting ulcerative surface is painless, regular rounded, red in color with smooth, raised edges and an infiltrated sebaceous bottom. Lymph nodes are compacted, enlarged, painless, and not fused to the skin and surrounding tissues. With secondary syphilis of the oral cavity, residual syphilomas are found, as well as a roseolous-papular rash on the palate, arches, and tonsils. Scraping the papules leads to exposure of erosive surfaces. In case of relapse of secondary syphilis of the oral cavity, fewer rash elements are formed, papules and roseolas are pale in color, grouped, forming figures resembling garlands and lace.

With secondary syphilis of the oral cavity, polyadenitis is detected. Unlike catarrhal tonsillitis, pain when swallowing and high temperature reaction are not observed with syphilitic lesions. In tertiary syphilis of the oral cavity, a gummous infiltrate is detected, after the disintegration of which a deep crater-shaped ulcerative surface is formed. The integrity of the jaws and nasal bones is compromised. The affected areas become scarred, leading to permanent deformities. There is no enlargement of regional lymph nodes. The detection of treponema pallidum in scrapings or in the contents of lymph nodes confirms the diagnosis of oral syphilis. To identify syphilitic lesions, serological reactions are also used, which in patients become persistently positive, starting from 4 weeks from the moment of formation of chancre. The first 3 weeks of primary oral syphilis are a seronegative period, since at this time it is not possible to confirm the diagnosis using serological reactions.

Radiographically, in patients with tertiary syphilis of the oral cavity, zones of rarefaction of bone tissue in areas corresponding to gummous lesions, as well as sclerotic changes along the periphery, are diagnosed. There is destruction of the cortical bone layer, signs of periostitis ossificans. Oral syphilis is differentiated from decubital ulcer, malignant tumor, tuberculous and actinomycotic lesions, tonsillitis, chancriform pyoderma, Setton's aphthae, lichen planus, leukoplakia. The patient is examined by a general dentist or dental surgeon. If a specific syphilitic infection is suspected, the patient is referred for consultation to the dermatovenerological department.

Treatment of oral syphilis

Treatment of oral syphilis is carried out in a specialized venereological dispensary. Locally, washing syphilitic lesions with antiseptics is indicated. For this purpose, chloramine-based products are often used in dentistry. Bulging granulations are cauterized with chromic acid solutions. If signs of pulp non-viability are identified, endodontic treatment is carried out in accordance with the principles of treatment of chronic periodontitis. In most cases, after canal filling, tooth mobility decreases.

In the phase of severe symptoms, surgical intervention aimed at removing the formed sequestration is not performed. Sequestrectomy for oral syphilis is indicated only after the clinical manifestations of the disease have subsided. During the period of remission, sanitizing measures are carried out, consisting of removing dental plaque, treating caries and its complications. With early treatment and comprehensive comprehensive treatment, the prognosis for oral syphilis is favorable. After recovery and deregistration, the resulting defects are subject to surgical plastic surgery.