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Mouth cancer

Syphilitic ulcer mimicking oral cancer

British Dental Journal volume 235, pages 957–958 (2023)Cite this article

Using this case, we would like to raise awareness of a differential diagnosis for specific oral lesions and demonstrate their ability to mimic that of oral malignancy. Oral syphilitic lesions are usually of acute onset, indurated, painless and occasionally ulcerated which can lead general dental practitioners (GDPs) to consider oral cancer. In the UK, the prevalence of syphilis has increased since 2010, almost tripling from 2,648 to 7,505 recorded in 2021.1,2 It is well recognised that syphilis has a higher incidence in men who have sex with men (MSM)1,2 and it may be a harbinger of underlying human immunodeficiency virus (HIV) infection (AIDS).3 Failure in access to primary care services and therefore screening, complicated by the COVID-19 pandemic, may be contributing to more recent rises.4 In its tertiary phase, it is life-threatening but screening and treatment with penicillin have reduced the tertiary progression rates.

This case highlights one clinical presentation of oral syphilis mimicking oral malignancy. We hope it promotes syphilis as a differential diagnosis, in line with a global increase in prevalence, even in those with no positive sexual history. We hope GDPs may consider taking sexual histories when required and consider their role in syphilis screening, especially when there is great pressure on primary care services at present.

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References

  1. Public Health England. Tracking the syphilis epidemic in England: 2010 to 2019 - An update on progress towards the syphilis action plan prevention priorities. 2021. Available at: https://assets.publishing.service.gov.uk/media/60129d878fa8f5655136505a/Syphilis_Action_Plan_Metrics_2010_to_2019_report.pdf (accessed November 2023).

  2. UK Health Security Agency. Syphilis in England, 2019 to 2021. 2022. Available at: https://www.gov.uk/government/publications/syphilis-quarterly-data-for-england/syphilis-in-england-2019-to-2021 (accessed November 2023).

  3. Soares A B, Gonzaga H F S, Jorge M A et al. Oral manifestations of syphilis: a review. J Venom Anim Toxins incl Trop Dis 2004; 10: 2-9.

  4. Dos Santos M M, de Souza Rosendo T M S, Lopes A K B, Roncalli A G, de Lima K C. Weaknesses in primary health care favor the growth of acquired syphilis. PLOS Negl Trop Dis 2021; doi: 10.1371/journal.pntd.0009085.

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Authors and Affiliations

  1. Speciality Doctor in Oral and Maxillofacial Surgery, East Kent Hospital University Foundation Trust, William Harvey Hospital, Kennington Road, Willesborough, Ashford, TN24 0LZ, United Kingdom

    T. Gouk

  2. Consultant Head and Neck Histopathologist, East Kent Hospital University Foundation Trust, Kennington Road, Willesborough, Ashford, TN24 0LZ, United Kingdom

    E. Nissanka-Jayasuriya

  3. Fellow in Oral and Maxillofacial Surgery, East Kent Hospital University Foundation, Kennington Road, Willesborough, Ashford, TN24 0LZ, United Kingdom

    L. Anushan Hiranya Jayasinghe

  4. Fellow in Oral and Maxillofacial Surgery, East Kent Hospital University Foundation Trust, Kennington Road, Willesborough, Ashford, TN24 0LZ, United Kingdom

    S. Withanage

  5. Consultant Maxillofacial/Head & Neck Surgeon, East Kent Hospital University Foundation Trust, William Harvey Hospital, Kennington Road, Willesborough, Ashford, TN24 0LZ, United Kingdom

    S. Doumas

Authors
  1. T. Gouk
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  2. E. Nissanka-Jayasuriya
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  3. L. Anushan Hiranya Jayasinghe
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  4. S. Withanage
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  5. S. Doumas
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Corresponding authors

Correspondence to T. Gouk, E. Nissanka-Jayasuriya, L. Anushan Hiranya Jayasinghe, S. Withanage or S. Doumas.

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Gouk, T., Nissanka-Jayasuriya, E., Anushan Hiranya Jayasinghe, L. et al. Syphilitic ulcer mimicking oral cancer. Br Dent J 235, 957–958 (2023). https://doi.org/10.1038/s41415-023-6696-6

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