Written on October 5, 2023 by Sendra Yang, PharmD, MBA. To give you technically accurate, evidence-based information, content published on the Everlywell blog is reviewed by credentialed professionals with expertise in medical and bioscience fields.
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Sexually transmitted diseases, or STDs, are more prevalent than you may think. The Centers for Disease Control and Prevention (CDC) indicate that almost one in five Americans have an STD. One of the most common STDs is syphilis. In 2018, a reported $174 million in direct medical costs were attributed to syphilis. Syphilis is an infection that can manifest in various ways and parts of the body. When syphilis occurs in the mouth, it is known as oral syphilis.[2,3]
Syphilis is an STD that is caused by a bacteria known as Treponema pallidum. Oral syphilis occurs when the oral cavity or mouth is infected with the bacteria.[2,3] There are various stages that syphilis follows as it progresses. The different stages — primary, secondary, latent, and tertiary syphilis — can last anywhere from weeks to months and even years.
The oral cavity ulcerations present in the primary stage of syphilis are often unnoticed by the individual and their healthcare provider. These oral lesions may be mistaken for other previous mucocutaneous diseases. Mouth ulcers can develop on the lip and, more rarely, on the tongue. The pharynx or tonsils are even more seldom affected.
Oral syphilis in the secondary stage of the infection can be more extensive than the regular type of syphilis infection. Oral lesions appear in at least 30% of those with secondary syphilis. Two specific features that predominate in the secondary stage of oral syphilis are mucous patches and maculopapular lesions, which are usually large, raised, and gray or white.[2-4] Symptoms of secondary syphilis in the mouth may also include sore throat.[2,4] The secondary stage of oral syphilis may seem to disappear without treatment, but the infection will progress into the latent and maybe even tertiary phases.
The risk of being infectious decreases significantly in the latent stage of oral syphilis. However, infectiousness can continue into the tertiary stage. In tertiary syphilis, the oral complications include gumma formations, a tumor-like growth that appears on the hard palate and tongue and rarely on the soft palate. Another issue with tertiary syphilis is syphilitic leukoplakia, where a similar white path appears on areas of the tongue. Tertiary oral syphilis can also lead to neurosyphilis.
Syphilis is spread through vaginal, anal, and oral sex. The microbe can enter the body via direct contact with the sores of an infected person. The syphilis sores are called chancre and can be present in, on, or around the penis, vagina, anus, rectum, and lips or mouth.[2,3] If the mouth or oral cavity comes into contact with the sores of an infected person, then the bacteria can infect the area. Primary syphilis usually happens due to orogenital or oroanal contact with infectious lesions.
You can take steps to reduce the risks of getting oral syphilis. Understanding that adequate and proper treatment cures the disease will help prevent oral syphilis progression and transmission. It’s important to note that reinfection does occur if prevention methods are not used. Using condoms correctly every time you have sex can reduce the risk of getting or giving syphilis. Condoms cover infected areas and sites of potential exposure, providing protection that helps to reduce transmission. Additionally, co-infection with HIV and syphilis is not uncommon; thus, getting tested is essential.
If you have questions about oral syphilis, you should speak with a healthcare provider. At Everlywell, on-demand STD appointments allow you to connect with a certified clinician in less than 2 hours to discuss your sexual health concerns. These virtual visits are typically 20 to 30 minutes long. During the appointment, a personalized care plan will be provided along with the next steps based on your symptoms and exposure history.
You can also consider getting an at-home syphilis lab test through Everlywell to check for antibodies to Treponema pallidum, the bacteria that causes the infection. The test cannot distinguish between an active syphilis infection and a successfully treated infection. If your test results are abnormal, you will have an opportunity to connect with a healthcare provider to discuss your case and next steps at no additional cost.