Mucosal ulcers follow oral sex. It is anecdotally reported that some STI clinics are beginning to see increasing numbers of homosexual men who have acquired infection in this way
because they think that oral sex is ‘safe’ (see Figs. (a) and (b)).
♦ A Male, aged 59 years, with a mucosal lesion on the buccal mucosa following oral sex.
♦ Female, aged 16 years, with a mucosal lesion on the
hard palate following oral sex. Serologic tests for syphilis
were strongly positive. No organisms could be identified,
but a biopsy showed a histologic appearance consistent
Perforation of the hard palate
Perforation of the hard palate is a late manifestation of syphilis and is now of historical interest (shown in Fig. (c)).
♦ Male, aged 46 years, with perforated hard palate.
He also had Argyll Robertson pupils, which is one of the
clinical signs of neurosyphilis. The pupils are small and do not
react to light, but convergence is retained.
Squamous cell carcinoma of the tongue
Squamous cell carcinoma (SCC) of the tongue is a late manifestation of syphilis. The patient illustrated here, a male aged 75 years, had positive serologic tests for syphilis (see Fig. d ). These SCCs almost always occur in the middle of the upper surface of the tongue. This is a different location from the usual SCC of the tongue, which is the lateral border of the tongue. When one sees what appears to be an SCC in this location, one must consider syphilis or that it is a nonmalignant lesion associated with the presence of a benign tumor of the tongue a granular cell tumor, which causes a pseudoepitheliomatous hyperplacia in the squamous epithelium.
♦ Squamous cell carcinoma of the upper surface of
the tongue in a male, aged 75 years, who had positive serologic tests