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Syphilis is a primarily sexually transmitted chronic infection caused by the spirochete, Treponema pallidum. There has been a dramatic increase in cases of syphilis in the Western world, with cases tripling in England between 2010 and 2019. Syphilis can present in a dental setting and dentists should enquire about sexual history if suspicious of syphilis to ensure early diagnosis and treatment. We present five cases seen with variable presentations of oral syphilis between 2016 and 2021 in a dental hospital.
CPD/Clinical Relevance: Increased awareness of syphilis among the dental team is essential to ensure early referral, diagnosis and treatment.
Article
Syphilis is a chronic infection caused by the anaerobic filamentous spirochete, Treponema pallidum, with sexual contact the primary mode of transmission.1 There has been a dramatic increase in the prevalence of syphilis in the Western world.2 The incidence of syphilis in England has tripled in the last 10 years, rising from 2648 in 2010 to 7982 in 2019.3 Women and men of Black ethnic backgrounds experience the highest rate of diagnoses; however, most infectious syphilis diagnoses are made among those of white ethnicity.3 Although men who have sex with men (MSM) account for 78.4% of new diagnoses, there has also been a dramatic increase among heterosexuals. The increase in cases is clustered around large urban centres, primarily London, Brighton and Hove, Blackpool and Manchester.3 Of MSM infected with syphilis, approximately 40% have co-infection with HIV-1.4 Although syphilis is usually diagnosed by specialist sexual health services, initial presentation may present in other settings including dental practices. Oral manifestations of syphilis can mimic other diseases, including recurrent aphthous stomatitis, traumatic ulceration and, less commonly, vesiculobullous disorders. Therefore, establishing the diagnosis can be challenging. Dental practitioners should enquire about sexual history if the diagnosis is suspected. This avoids a delay in diagnosis and subsequent treatment, without which can lead to severe cardiovascular, ocular and neurological complications.5
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