Secondary Syphilids of the Mucous Membranes

Secondary syphilids of the mucous membranes are quite common and because of the fragility of the tegmental epithelium and frequent maceration are very hazardous as regards transmission of infection not only by the sexual routes, but by close everyday contact. The oral cavity, throat, larynx, vermilion border and the mucous membranes of labia majora and minora are most frequently involved. Macular, papular and pustular syphilids occur here, just as on the skin. Most syphilologists admit the possibility of syphilitic roseola forming on the mucous membranes, but pink colour of the mucosa makes this eruption practically indistinguishable. The large erythematous areas of coalesced roseolar lesions on the tonsils and soft palate (erythematous, syphilitic tonsillitis) may be localized both unilaterally and bilaterally and there are no attendant subjective sensations, general symptoms or increased body temperature as a rule. Moreover, the discrete boundary of the erythematous foci and their bluish shade make it possible to differentiate the condition from catarrhal tonsillitis of streptococcal etiology. Skripkin states that erythematous tonsillitis as a manifestation of mucosal macular syphilids is encountered in 47 to 55 per cent of patients suffering from secondary syphilis.

Syphilitic papules are the most common lesions of the mucous membranes. Lenticular papules prevail. They are flat, round, intensively dark red, hard to the touch, sharply demarcated and slightly elevated above the skin surface. Papular tonsillitis develops in 12 to 15 per cent of patients with secondary syphilis. Because the epithelium of the oral mucosa is macerated, the papules acquire a whitish opal colour with a dark-red ring on the periphery and then undergo erosion; the papules coalesce quite often. The soft palate, lips, the mucous membrane of the tongue (mostly its edge) and gums are the sites of oral syphilitic papules besides the tonsils. The mucosal papules usually cause no subjective sensations, but when they undergo erosion and secondary infection occurs, tenderness develops and a hyperemic zone forms around them. In localization of the papules in the larynx, on the vocal cords, the voice becomes hoarse (raucedo) and, in rare cases, total aphonia develops. Differential diagnosis is made with various forms of tonsillitis, diphtheria and Vincent's tonsillitis, which are characterized by a sudden onset, acute course, pain, and severe systemic phenomena. Ulcers, and erosions in aphthous stomatitis are marked by sharp tenderness, absence of infiltration, by intensive hyperemia around the erosions, an acute onset and, at times, by strands or remnants of bullae forming a ring around the erosions. It is sometimes difficult to differentiate papules and patches of lichen ruber planus localized in the mouth, particularly if they form on the tongue mucosa. In such cases the results of serological blood tests are considered as well as the character of the lesions, if such are present on other body areas (the skin of the trunk, limbs, genitals). Pustular syphilids are no longer encountered on the mucous membranes.