Syphilis rates are at their highest since 1993, with 8.7 cases per 100,000 people in 2015 and 2016, according to the Centers for Disease Control and Prevention (CDC). And that means dentists should be prepared to spot its symptoms, according to assistant professor Shruti Kashikar, DDS, at the Rutgers School of Dental Medicine (RSDM).
“Syphilis is back, and it is more important than ever to catch this disease early,” said Kaskikar, who treated two cases of syphilis during her oral and maxillofacial pathology residency at New Presbyterian Hospital in New York. “Oral manifestations can be seen at all stages of syphilis in men, women, and children. It is up to us, as oral healthcare providers, to diagnose and treat these patients before it’s too late.”
Syphilis is transmitted through sexual contact and needle sharing. Rates declined after 1943 when penicillin was discovered, though they began to climb again in the early 2000s. Left untreated, systemic manifestations may emerge including heart complications, neurological symptoms, problems with the eyes, bones, and skin, and, in some cases, death. Before penicillin, the disease often severely disfigured patients.
Oral symptoms include non-specific ulcers and white mucosal patches on the tongue and lips. Ulcerated lesions that increase in size and firmness, perforations of the palate, and nodular growths on the tongue also are symptoms.
Transmitted from mother to child during pregnancy, congenital syphilis can lead to Hutchinson’s teeth, which are notched incisors, and mulberry molars, which have many small bumps like the mulberry fruit, Kaskikar said. About 40% of fetuses and newborns with congenital syphilis don’t survive, the CDC reports. Children with congenital syphilis can go deaf or blind, while others may have severe anemia and bone deformities.
At RSDM, suspected cases of syphilis can be biopsied. Those that are confirmed must be reported to the CDC, which tracks syphilis cases. Sexual partners and those who have shared needles with syphilis patients also must be tested for the disease. It is most prevalent among gay men, though it also has spread among intravenous drug users. In 2015 and 2016, rates increased among men by 14.7% and among women by 35.7%, according to the CDC.
In 1494, the first European case was reported in Naples, Italy. Early on, physicians believed it was caused by astrological forces before realizing that it was sexually transmitted. Attitudes toward the disease have changed, with blame assigned to various people and nationalities as well as to women, especially prostitutes.
“The stigmatization of female sexuality is clearly depicted in art by various artists throughout the 18th and 19th century,” said Kashikar. “With time, however, attitudes have changed, along with the demographics of the disease.”
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