Syphilis: a re-emerging disease. An update for the dental practitioner

Syphilis is a chronic infection caused by the anaerobic filamentous spirochete, Treponema pallidum, with sexual contact the primary mode of transmission.¹ There has been a dramatic increase in the prevalence of syphilis in the Western world.² The incidence of syphilis in England has tripled in the last 10 years, rising from 2648 in 2010 to 7982 in 2019.³ Women and men of Black ethnic backgrounds experience the highest rate of diagnoses; however, most infectious syphilis diagnoses are made among those of white ethnicity.³ Although men who have sex with men (MSM) account for 78.4% of new diagnoses, there has also been a dramatic increase among heterosexuals. The increase in cases is clustered around large urban centres, primarily London, Brighton and Hove, Blackpool and Manchester.³ Of MSM infected with syphilis, approximately 40% have co-infection with HIV-1.⁴ Although syphilis is usually diagnosed by specialist sexual health services, initial presentation may present in other settings including dental practices. Oral manifestations of syphilis can mimic other diseases, including recurrent aphthous stomatitis, traumatic ulceration and, less commonly, vesiculobullous disorders. Therefore, establishing the diagnosis can be challenging. Dental practitioners should enquire about sexual history if the diagnosis is suspected. This avoids a delay in diagnosis and subsequent treatment, without which can lead to severe cardiovascular, ocular and neurological complications.⁵