The oral presentation of secondary syphilis among men: the evolving interplay between syphilis, HIV and prophylactic strategies

Abstract

Syphilis has been intricately linked with HIV because of shared transmission pathways and because these infections promote each other’s transmission. In addition, HIV infection may change the clinical presentation and management of syphilis lesions. Initially, the HIV epidemic had improved safe sex practices among men who have sex with men (MSM), but subsequent effective treatment and prophylaxis strategies, have resulted in behavioural disinhibition and a resurgence of syphilis.  Here, we report on three cases of oral secondary syphilis and explore the relationship between oral syphilis and sexual practices, HIV and prophylactic measures that MSM employ. Three men, who presented to the University of Pretoria Oral Health Centre (UPOHC), complaining of oral lesions, were diagnosed by histopathology with secondary syphilis. The clinical appearance of the lesions, HIV status, treatment and prophylaxis employed by the men were documented. The clinical presentation, sexual practices, HIV status and prophylactic measures among these men differed and demonstrate the complexity of oral secondary syphilisdiagnosis and management.Syphilis presents variably in the oral cavity, and this may be linked to the sexual practices and HIV status of the patient.