Oral Syphilis Responds to Topical Antibiotic Therapy but Still Needs Definitive Systemic Treatment

  • Ahn, Kyu-Hyeon (Department of Oral Pathology, School of Dentistry, Dental Science Research Institute, Chonnam National University) ;
  • Ji, Hyeong-Joon (Department of Oral Pathology, School of Dentistry, Dental Science Research Institute, Chonnam National University) ;
  • Kim, Ok-Joon (Department of Oral Pathology, School of Dentistry, Dental Science Research Institute, Chonnam National University) ;
  • Kim, Byung-Gook (Department of Oral Medicine, School of Dentistry, Chonnam National University) ;
  • Im, Yeong-Gwan (Department of Oral Medicine, Chonnam National University Dental Hospital)
  • Received : 2018.02.14
  • Accepted : 2018.03.09
  • Published : 2018.03.30


Syphilis, one of the most common sexually transmitted diseases, is caused by the microorganism Treponema pallidum. Syphilis consists of several clinical stages that may include signs in the oral and perioral regions. Syphilis is treated effectively with systemic antimicrobial therapy using antibiotics such as penicillin. This article describes a case where topical antibacterial therapy with doxycycline was effective in treating oral papular lesions associated with primary syphilis in a 24-year-old male. He was immediately referred to a dermatologist, and antibiotic therapy was administered in response to positive diagnostic test results for syphilis. Although oral syphilitic lesions may be resolved by dental professionals using topical treatments, syphilitic infections should be managed in consultation with medical specialists using systemic antibiotic therapy.


  1. Ficarra G, Carlos R. Syphilis: the renaissance of an old disease with oral implications. Head Neck Pathol 2009;3:195-206.
  2. Fukuda H, Takahashi M, Kato K, Oharaseki T, Mukai H. Multiple primary syphilis on the lip, nipple-areola and penis: an immunohistochemical examination of Treponema pallidum localization using an anti-T. pallidum antibody. J Dermatol 2015;42:515-517.
  3. Seibt CE, Munerato MC. Secondary syphilis in the oral cavity and the role of the dental surgeon in STD prevention, diagnosis and treatment: a case series study. Braz J Infect Dis 2016;20:393-398.
  4. Carbone PN, Capra GG, Nelson BL. Oral secondary syphilis. Head Neck Pathol 2016;10:206-208.
  5. Murrell GL. Secondary syphilis oral ulcer. Otolaryngol Head Neck Surg 2009;140:942-943.
  6. Ratnam S. The laboratory diagnosis of syphilis. Can J Infect Dis Med Microbiol 2005;16:45-51.
  7. Douglas JM Jr. Penicillin treatment of syphilis: clearing away the shadow on the land. JAMA 2009;301:769-771.
  8. Clement ME, Okeke NL, Hicks CB. Treatment of syphilis: a systematic review. JAMA 2014;312:1905-1917.
  9. Kelner N, Rabelo GD, da Cruz Perez DE, et al. Analysis of nonspecific oral mucosal and dermal lesions suggestive of syphilis: a report of 6 cases. Oral Surg Oral Med Oral Pathol Oral Radiol 2014;117:1-7.
  10. Strieder LR, Leon JE, Carvalho YR, Kaminagakura E. Oral syphilis: report of three cases and characterization of the inflammatory cells. Ann Diagn Pathol 2015;19:76-80.
  11. Neville BW, Damm DD, Allen CM, Chi AC. Oral and maxillofacial pathology. 4th ed. St. Louis: Elsevier; 2015. pp. 170-174.
  12. Drago F, Ciccarese G, Broccolo F, et al. A new enhanced antibiotic treatment for early and late syphilis. J Glob Antimicrob Resist 2016;5:64-66.
  13. Hook EW 3rd, Martin DH, Stephens J, Smith BS, Smith K. A randomized, comparative pilot study of azithromycin versus benzathine penicillin G for treatment of early syphilis. Sex Transm Dis 2002;29:486-490.
  14. Liang Z, Chen YP, Yang CS, et al. Meta-analysis of ceftriaxone compared with penicillin for the treatment of syphilis. Int J Antimicrob Agents 2016;47:6-11.
  15. Dai T, Qu R, Liu J, Zhou P, Wang Q. Efficacy of doxycycline in the treatment of syphilis. Antimicrob Agents Chemother 2016;61:e01092-16.
  16. Beale JM Jr, Block JH. Wilson and gisvold's textbook of organic medicinal and pharmaceutical chemistry. 12th ed. Baltimore: Lippincott Williams & Wilkins; 2011. pp. 307.
  17. Zhang H, Zhang J, Streisand JB. Oral mucosal drug delivery: clinical pharmacokinetics and therapeutic applications. Clin Pharmacokinet 2002;41:661-680.
  18. Rathbone MJ, Pather I, Senel S. Chapter 2 overview of oral mucosal delivery. In: Rathbone MJ, Senel S, Pather I, eds. Oral mucosal drug delivery and therapy. New York: Springer; 2015. pp. 17-22.
  19. Patel VF, Liu F, Brown MB. Advances in oral transmucosal drug delivery. J Control Release 2011;153:106-116.