What Are the Initial Symptoms of Oral Syphilis?
Syphilis is primarily transmitted through sexual contact. When it flares up, patients may experience skin ulceration, itching, and water rash. Oral manifestations often include painless ulceration, marginal erythema, and oral mucosal ruptures. Patients require medication for oral treatment and should also pay attention to their daily diet. Syphilis is more responsive to treatment in the early stages, but becomes uncontrollable in the tertiary stage.
1. Primary Syphilis: After the syphilis spirochete enters the skin or mucosa, it begins to proliferate and cause local inflammation. Ulcers and erosions occur at the site of entry 2-4 weeks later, known as chancroid. Chancroid is most commonly seen in the coronal sulcus, glans penis, and penis in men, and in the labia minora and majora in women. Chancroid is usually a single lesion, sometimes multiple, with a diameter of 1-2 cm. It is a circular or elliptical painless ulcer with raised edges and a clean, non-purulent surface. It feels firm like cartilage when touched, hence the name hard chancroid. After a few days of chancroid onset, regional lymphadenitis may occur. Infected individuals may present with inguinal lymphadenitis, characterized by enlarged, mobile, but painless lymph nodes. As the body gradually develops immunity to the syphilis spirochete, chancroid usually resolves naturally within 1 month.
2. Secondary Syphilis: After the resolution of chancroid, the spirochete continues to proliferate in the body. Within 1-2 months after primary syphilis, it can invade the skin, mucosa, and systemic organs. The symptoms of secondary syphilis often appear consecutively or simultaneously within 2 years of infection, with syphilis rash being the most prominent symptom. It is characterized by a widespread, symmetrical distribution throughout the body, with the palms, feet, anus, and genital areas being the most commonly affected. The rash may resolve naturally after several weeks or months. The rash of secondary syphilis is primarily macular and papular. The earliest and most common rash is the roseola, which is symmetrically distributed throughout the body and appears as copper-colored scaly patches on the palms and feet. The rash can vary in size, from small clusters to larger, lichenoid syphilis lesions. In a minority of patients, especially those with concurrent HIV infection, the prodromal symptoms may be pronounced, and diffuse papules, pustules, and ulcers may develop, known as malignant syphilis. Circular or oval grayish-white mucosal patches may occur on the lips, cheeks, and tongue. These lesions are bright grayish-white and slightly raised, often circular, oval, or ring-shaped, with a tendency for central erythema and erosion. These lesions harbor a large number of spirochetes and are highly contagious. Secondary syphilis may resolve spontaneously, or the disease may remain quiescent for months to years.
3. Tertiary Syphilis: Up to 40% of untreated syphilis patients may develop various late-stage symptoms 2-3 years or even more than 10 years after infection. Late-stage syphilis can affect any organ in the body, with cutaneous and mucosal syphilis being the most common manifestations. The spirochete is rarely present in the lesions and is generally non-contagious. The lesions are often localized to certain areas, such as the limbs, head, face, and back, and are painless but often result in significant destruction and scarring.
