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Oral Manifestations of Syphilis: a Review of the Clinical and Histopathologic Characteristics of a Reemerging Entity with Report of 19 New Cases

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Abstract

Background

Syphilis is a sexually-transmitted infectious disease caused by Treponema pallidum. Cases of primary and secondary syphilis are on the rise in the United States, with a 14.4% increase in new cases noted from 2017 to 2018 and an escalation of 71% between the years 2014 and 2018. Fulfilling its nickname of “the great imitator,” oral manifestations of syphilis may mimic a variety of infectious, neoplastic, or immune-mediated processes, both clinically and histopathologically. This large spectrum of appearances can create a diagnostic challenge to the clinician and/or pathologist, leading to delay in diagnosis or misdiagnosis.

Methods

A database of oral syphilis cases was created from archives at the University of Kentucky, University of Pittsburgh, LIJMC, Columbia University MC, and University of Tennessee. The age, sex, race, location, duration, and clinical description were recorded. Cases without positive reaction upon immunohistochemistry or serologic tests were excluded.

Results

We identified 19 new cases of oral syphilis (17 males, one female, and one case unknown sex) and described the clinical and histopathological features of this re-emerging and potentially fatal disease. All cases demonstrated dense lymphoplasmacytic inflammation, often with inflammatory exocytosis or ulceration at the surface, and perivascular inflammation.

Conclusions

Early recognition of the histopathologic and clinical manifestations of oral syphilis is imperative for prompt diagnosis, improved patient outcomes, and disease prevention.

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Acknowledgements

The authors thank Drs. Kevin Andrus, Matthew Conquest, Craig Fowler, P. Shawn Stopperich, Anthony Tortorich, and Shane Wilson for their contribution of case information and/or clinical photographs.

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Authors and Affiliations

  1. Division of Oral and Maxillofacial Pathology, University of Kentucky College of Dentistry, 800 Rose Street, Rm. 530, Lexington, KY, 40536, USA

    Molly Housley Smith

  2. Oral and Maxillofacial Pathology Specialty Care Unit, A.T. Still University—Missouri School of Dentistry & Oral Health, St. Louis, MO, USA

    Richard J. Vargo

  3. Department of Diagnostic Sciences, University of Pittsburgh School of Dental Medicine, G-135 Salk Hall, 3501 Terrace St., Pittsburgh, PA, USA

    Elizabeth Ann Bilodeau

  4. Department of Diagnostic Sciences, The University of Tennessee College of Dentistry, Memphis, TN, USA

    K. Mark Anderson

  5. Head and Neck Pathology Fellow, Department of Pathology, The University of Chicago, Chicago, IL, USA

    Anna Trzcinska

  6. Division of Oral and Maxillofacial Pathology, Columbia University Medical Center, New York, NY, USA

    Carleigh R. Canterbury

  7. Department of Dental Medicine, Division of Oral and Maxillofacial Pathology, Long Island Jewish Medical Center, Zucker School of Medicine At Hofstra Northwell Health, New Hyde Park, NY, USA

    John E. Fantasia

  8. Department of Surgical Sciences, Marquette University School of Dentistry, Milwaukee, WI, USA

    Yeshwant B. Rawal

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  1. Molly Housley Smith
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Contributions

MHS: Main author, corresponding author and contributor of most cases. RJV: Critical review, contribution of cases, wrote a portion of the manuscript. EAB: Critical review, contribution of cases. MA: Critical review, contribution of cases. AT: Critical review, wrote a portion of the manuscript. CRC: Critical review, contribution of cases. JEF: Critical review, contribution of cases. YBR: Critical review, contribution of cases.

Corresponding author

Correspondence to Molly Housley Smith.

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Conflict of interest

The authors declare that they have no conflict of interest.

Ethical Approval

This retrospective review study involving de-identified human participants was performed in accordance with the principles of the Declaration of Helsinki.

Informed Consent

Consent was waived or the cases were exempt in accordance with the institutional review boards at the institutions from where the cases originated (the University of Kentucky, the University of Pittsburgh School of Dental Medicine, Northwell Health Long Island Jewish Medical Center, Columbia University Medical Center, and University of Tennessee College of Dentistry).

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Smith, M.H., Vargo, R.J., Bilodeau, E.A. et al. Oral Manifestations of Syphilis: a Review of the Clinical and Histopathologic Characteristics of a Reemerging Entity with Report of 19 New Cases. Head and Neck Pathol 15, 787–795 (2021). https://doi.org/10.1007/s12105-020-01283-4

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  • DOI: https://doi.org/10.1007/s12105-020-01283-4

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