Sir, I would like to present an interesting case recently encountered in the maxillofacial unit, which aims to raise awareness amongst dental professionals of a relevant and re-emerging infectious disease.

A 23-year-old soldier was referred with a one-month history of 'oral ulceration'. At presentation the patient was complaining of soreness in the palate, tongue and retromolar region, along with a 'sore throat'.

The patient gave a history of a nine-month period of 'flu-like' symptoms. He was also concerned for an unexplained loss in weight of two stone over a two-month period.

Intra-oral findings included: nodules in the dorsum of the tongue (Fig. 1), vesicles in the right retromolar region, and a raised erythematous nodule in the palate. Alongside this, there was also bilateral tonsillar enlargement, and left jugulo-diagastric lymphadenopathy.

Figure 1
figure 1

Patient presenting with nodules in the dorsum of the tongue

Full size image

The differential diagnoses included: candida infection, secondary syphilis, HIV, herpes simplex infection, tuberculosis, lichenoid reaction, and lichen planus. Blood tests showed a strongly positive result for syphilis total antibody, representing early syphilis (within two years of acquisition).

The patient was urgently referred to the sexual health department, where a confirmatory syphilis screen was carried out, and subsequently treated with one dose of benzathine penicillin G 2.4 million units IM. At this stage contact tracing was carried out by a trained health adviser, to notify all relevant partners of the potential risk of infection.

At a two week follow-up, the patient showed complete resolution of symptoms, and intra-oral lesions were no longer evident.

Further research into this infectious disease demonstrated some alarming statistics. Between 2003-2012, the Health Protection Agency reported a 49% increase in incidence of syphilis in England. As a result, dentists may be faced with patients infected with syphilis yet undiagnosed. Therefore, dentists can be crucial in detecting orofacial manifestations of untreated syphilis. It is important that syphilis is considered in the differential diagnoses by dental professionals for commonly occurring symptoms such as: oral ulceration, cutaneous rashes, lymphadenopathy and un-resolving malaise. Any of these presenting features should raise a high index of suspicion amongst dentists, and consequently the appropriate referral should be made for further testing.