opic 153: Syphilis.

The etiology, pathogenesis, clinical manifestations of the oral mucous

membrane, diagnosis. Treatment and prevention. The tactics of the dentist.

Questions for the control of students' knowledge.
1. The etiology and pathogenesis of syphilis. Clinical forms.
2. Manifestations in the oral cavity of primary syphilis. Diagnosis, differential diagnosis.
3. Manifestations in the oral cavity of secondary syphilis. Diagnosis, differential diagnosis. Manifestations in
the oral cavity of tertiary syphilis. Diagnosis, differential diagnosis.
4. Treatment and prevention of syphilis. The tactics of dentist.
Getting to the analysis of the theme underlines the important role of the teacher of a dentist in the diagnosis
of syphilis, gonorrhea, tuberculosis and leprosy, as these diseases often cause patients to the dentist is due to
lesions of the oral mucosa.
Syphilis - a chronic infectious disease caused by Treponema pallidum. Syphilis is a very peculiar process:
first, undulating change and periods of active displays latent infection, and secondly, the gradual and consistent
change in the clinical and pathologic lesions pictures of organs and tissues from mild inflammation to the
formation of specific infectious granulomas deep, compressing and damaging tissues and organs in which they
are localized, resulting in loss of organ function, and sometimes to death of the patient.
Next, the teacher stops on the classification of syphilis transmission ways.
Incubation period of syphilis averages 3-4 weeks, but it may as shortening (10-12 days) and elongation (up
to 6 months).
Primary syphilis period begins with the introduction of Treponema pallidum, solid chancre. The length of
this period - 6-7 weeks. 5-7 days after the formation of the chancre appears indispensable feature of the second
primary period - an increase in the regional lymph nodes (bubo, or regional scleradenitis).
From the lymph nodes, lymphatic system is to first primary period Treponema into the bloodstream in
response to it gradually begins to produce antibodies, which in the third week of the primary period in the blood
can be determined by classical serological somewhat earlier - with the aid of RIF and a little later - and with the
help RIBT. The chancre most patients maintained throughout the initial period and the beginning of next, second
period. During the last week of the primary period of syphilis develops polyadenylation, continuing in the next
2-3 months.
Next, the teacher with the students examines in detail the clinical picture of a chancre on the mucosa of the
mouth and red border of lips and proceeds to its differential diagnosis (with herpes simplex, chronic recurrent
avtoze stomatitis, shankriforme pyoderma, banal angina, cancer, ulcers, ulcerative-milliar tuberculosis,
traumatic erosions or ulcers, erosions in lichen planus, lupus erythematosus, leukoplakia, trophic ulcers).
Detection of Treponema pallidum is crucial in the diagnosis of primary syphilis. In the absence of a chancre in
the discharge of Treponema pallidum, it can be found in a punctate of the regional lymph node.
The secondary period of syphilis begins after 6-7 weeks after submission of the chancre, when the
background of symptoms attributable to the period of primary syphilis (chancre, regional scleradenitis,
polyadenylation), there is abundant roseolous-papular rash. Second period lasts for 3-5 years and is
accompanied by a positive serological reactions.
The peculiarity of the secondary period of syphilis is a fluctuating course, with periods of active symptoms
of the disease followed by periods of latent, asymptomatic disease. The duration of each periods is individual
(average of 1.5-2 months). The secondary period of syphilis is characterized by a large number pallid treponem
in rashes and as a result a large infectivity and at the same time, a benign course: emerging in this period tend to
rash and without treatment to a complete regression. This applies not only to the skin and mucous membranes,
but also the internal organs, the nervous system. Over time, the disease is multi-shift recurrence of syphilis and
latent period, and the more time that has passed since the infection, the longer latency periods and smaller
lesions in recurrent.
The teacher emphasizes that the oral mucosa is a frequent and sometimes the only place syphilides
localization in the secondary period. Almost half of the patients with symptoms of secondary syphilis lesions are
observed in the form of OMM and roseolous papular elements. Pustular eruptions in the mouth are extremely
rare.
Roseolous rash on the mucous membrane of the mouth is differentiated with banal catarrhal angina, drug
eruptions. Syphilitic papules on OMM may resemble leukoplakia, lichen planus papules, lesions of lupus
erythematosus, chronic hyperplastic candidiasis, geographic tongue. Eroded syphilitic papules should be
distinguished from multiforme exudative erythema, bull pemphigoid, real pemphigus, a simple bubble zoster.
Tertiary syphilis is not observed in all patients, even if they are not treated. It begins in 4-6 years after the
beginning of disease has malignant course. Tertiary period lasts for decades, characterized by the development

of inflammatory infiltrates (gummas and tubercles) are prone to decay and often cause significant destructive,
sometimes incompatible with life changes in organs and tissues. At the same time, a rash of tertiary syphilis are
not infectious to others, as in the discharge there is no pathogen. Active or symptomatic and latent tertiary
syphilis are distinguished. Classical serological tests for active forms of tertiary syphilis are positive in 70-80%
of patients at latent - at 50-60%. However, RIF and RIBT positive in all patients with tertiary syphilis.
The symptoms of tertiary syphilis appear suddenly, rashes are monomorphic, scant, grouped asymmetric. In
the process involves the internal organs, the nervous system, bone. In the tertiary period on OMM may appear
Gunma, gummy diffuse infiltration and papulose rash. In this case, oral mucosa may be the only place of the
clinical manifestations of the disease.
Gummy ulcer is differentiated from other ulcers including a solid chancre. A papulous syphilide
distinguished from tuberculous lesions of OMM, cancerous ulcers, leprosy.
Next, the teacher clarifies the students' knowledge on the subject of congenital syphilis.
Treatment of manifestations of syphilis in the mouth. Treatment is carried out by dermatovenereologists in
skin - venereologic clinics according to special treatments. Aspects of dental treatment - obligatory compliance
the rules of the infected patients (gloves, masks, etc.). Oral hygiene, observing precautions appointment of local
symptomatic treatment.
7. Practical skills of the topic:
1.
Conducting a clinical examination of the patient with tuberculosis: trustee contact with patients,
special attention to the complaints, not only from the mouth, but also from the organs and systems; determine
anamnesis of disease, anamnesis of life to find possible exposure routes, with an objective study to pay attention
to the condition of the lymph nodes, skin condition. In the mouth to reveal the presence of elements of defeat.
Material capture for cytologic research.
2.
Analysis of the results of cytological, serological reactions and results of immobilization of pale
treponem (RIPT)
3.
Making history, a plan of examination and treatment of patients with syphilis;
4.
Writing out the direction to the dermatovenerologic dispensary;
5.
Carrying out of application anesthesia.
6.
Conducting irrigation, applications of non-specific and specific medicines.
8. Terminology (in Latin script).
Syphilis (syphilis, lues), pale treponema (Treponema palidum), solid chancre (ulcus durum). Syphilide
(siphilid).
9. Questions for the control of students' knowledge.
1. The etiology and pathogenesis of syphilis. Clinical forms. 2. Manifestations in the oral cavity of primary
syphilis. Diagnosis, differential diagnosis. 3. Manifestations in the oral cavity of secondary syphilis. Diagnosis,
differential diagnosis. Manifestations in the oral cavity of tertiary syphilis. Diagnosis, differential diagnosis. 4.
Treatment and prevention of syphilis. The tactics of dentist.
10. Tasks "CROK 2".
1.
The 38 years old patient complains of presence of ulcer on the lower lip, which appeared three
weeks ago and has not disappeared despite self-care. Somatic pathology denies. 1.5 months ago came from
vacation. Objective: visible skin clean, without elements defeats. At the unchanged red border of the lower lip,
left side, oval erosion, covered "greasy" coating, painless on palpation, which is found at the base of dense
infiltration. Submental lymph nodes are enlarged, firm, painless, does not soldered with each other and
surrounding tissues. What examination is necessary to appoint the patient to confirm the diagnosis?
A. Clinical analysis of blood.
B. Histological examination.
C. Bacteriological examination.
D. Immunological study.
E. Virological examination.
2. A patient 28 years old complained of the presence of ulcers on the tongue. OBJECTIVE: there is dense
infiltration, erosion of red color with a smooth shiny bottom, diameter 1.5 cm, well-circumscribed, with smooth
edges, painless. What is the most likely diagnosis?
A. Dekubital ulcer
B. primary syphilis
C. tuberculous ulcer
D. actinomycosis of tongue

E. abscess of tongue
1.
The patient complains of 30 years for the presence of ulcers on the tongue. OBJECTIVE: on the
right back of the tongue ulcer saucer-shaped 1 cm in diameter, with raised edges, with a dense infiltrate around,
palpation painless. Lymph nodes on the affected side are enlarged, firm, painless. What is the most likely
diagnosis?
A. Setton's Aphtha.
B. Miliar- ulcerative tuberculosis.
C. Primary syphilis.
D. Dekubital ulcer.
E. A cancerous ulcer.
2.
The 23 years old patient complains of the presence of ulcers on the red border of the lower lip,
which does not lend itself to self-medication for two weeks. Objective: unchanged at the red border of the lower
lip - ulcer circular diameter of 2 mm with raised, smooth edges, the bottom of it - the meat-red, dense shiny,
with a "greasy coating;" palpation painless ulcer with a cartilaginous infiltrate. Regional lymph node is
enlarged, dense elastic consistency, painless, mobile. What is the most likely diagnosis?
A. lupus erythematosis
B. Dekubital ulcer
C. A cancerous ulcer
D. tuberculous ulcer
E. primary syphilis
3.
To the dentist addressed 38 years old patient complaining of the presence of ulcers on the lateral
surface of the tongue. OBJECTIVE: on left side of the tongue is defined a round shape painless on palpation
ulcer, up to 1 cm in diameter, with a smooth and slightly raised above the surface of the mucous edges. At the
bottom of it chondroid infiltrate. What is the most likely diagnosis?
A. tuberculosis
B. trophic ulcer
C. traumatic ulcer
D. syphilis
E. Actinomycosis
4.
Man 26-year-old complained of rash in the oral cavity. Objectively: the mucous of the soft palate
and the arches are defined papules with the size about 1 cm in diameter, slightly protruding above the surface of
the mucous membrane covered with a grayish plaque and surrounded by a narrow hyperemia aureole. When
scrape off - the plaque is removed by a spatula, then there is the meat-red color erosion. Submandibular lymph
nodes are enlarged, painless on palpation. What additional research methods necessary to conduct for this
patient?
A. Microscopy and culture to nutrient media
B. Microscopy and serological tests
C. Fluorescent and biopsy
D. Stomatoskopy and cytology
E. Cytology and luminescent
5.
Early diagnosis of primary syphilis is based on information:
A. Serological reaction of Wasserman
B. Dark field microscopy
C. fluorogram
D. immunofluorescence
E. haemogram
6.
Manifestations of primary syphilis in the mucous membrane of the mouth is:
A. soft chancre
B. solid chancre
C. gumma
D. papulose syphilide
E. pustulosis syphilide
7.
The most rare form of secondary syphilis, which is found in the mucous membrane of the mouth is
-syphilide:
A. Spotted
B. papulous

C. Pustulosis
8.
Infectious disease, which manifests itself in the mouth and having four periods in the course of the
disease - the incubation, the primary, secondary and tertiary:
A. tuberculosis
B. AIDS
C. flu
D. gonorrhea
E. Syphilis
9.
Period of syphilis, which lasts an average of 3-4 weeks:
A. incubatory
B. primary
C. secondary
D. Tertiary
10.
Period of syphilis, which lasts an average of 6-7 weeks:
A. incubatory
B. primary
C. secondary
D. Tertiary
11.
Period of syphilis, which lasts an average of 3-5 years:
A. incubatory
B. primary
C. secondary
D. Tertiary
12.
Period of syphilis, which lasts for decades:
A. incubatory
B. primary
C. secondary
D. tertiary
13.
The primary chancre of syphilis is differentiated with:
A. actinomycosis
B. traumatic ulcer
C. pemphigus
D. hypertrophic gingivitis
E. Manifestations of leukemia in the oral mucous membrane
14.
The character of the regional lymph nodes in recurrent syphilis:
A. not palpable
B. Enlarged, painful, soft, soldered
C. Enlarged, firm, free and painless
D. Enlarged, dense soldered, painful
E. Enlarged, free, painful, tight
15.
Tertiary syphilis is manifested in the mucous membrane of the mouth as a:
A. Hard and soft chancre
B. Papular and macula syphilides
C. Macula and pustular syphilides
D. Gummy and papulose syphilides
E. soft chancre
18. Hutchinson's triad (parenchymatous keratitis, Hutchinson's teeth, labyrinth deafness), perioral scars,
saddle nose, saber shins, wrong form of first molars and canines - the characteristic clinical signs of syphilis:
A. primary
B. recurrent
C. tertiary
D. congenital
E. Not occur in syphilis