Oral lesions are described in all stages of syphilis, except in the latent stage. During the secondary stage of infection, oral lesions, saliva and blood of infected person are very contagious. The aim of this case report was to point to the secondary syphilis in differential diagnosis of oral diseases.
A 30-year-old homosexual man presented with a three-week history of a painless verrucous lesion on his lower lip. Physical examination revealed a hypertrophic painless papillomatous lesion on the lower lip. The lesion was partly split with peripheral fissures. There were no generalized lymphadenopathies and no evidence of systemic disease. Further examination showed no other mucous membrane or cutaneous lesions elsewhere on the body. The external genitalia were normal. The patient was HIV-negative and otherwise healthy. A review of his medical history was significant for previous well documented treatment of anal chancre, which was successfully commenced at our Institute in 2010. It also revealed a history of a single unprotected receptive oral sex with an unknown partner 3 months before the onset of lesion. The diagnosis of condyloma latum on the lower lip was considered on clinical grounds. Laboratory findings, including complete blood count and blood chemistry were within normal limits. The VDRL (venereal disease research laboratory) test was positive with a titre of 1 : 128. Treponema pallidum hemagglutination assay (TPHA) was positive. HIV serology was non-reactive.
The final diagnosis of solitary condyloma latum on the lower lip, as the only sign of secondary syphilis, was confirmed by positive results of routine serologic tests for syphilis. The patient was diagnosed with secondary syphilis and treated with a single intramuscular injection of benzathine penicillin, 2.4 million units. The lesion regressed completely within 2 weeks. Three months later the VDRL titer had fallen to 1 : 8 and HIV serology remained negative.
Polymorphic oral manifestations in syphilis indicate that this disease should not be overlooked in the differential diagnosis of not only benign, but even malignant oral lesions.
In conclusion, as far as the world literature available to us is concerned, this would be the first report of isolated solitary condyloma latum on the oral lip that, in the absence of any other clinical signs or symptoms of the disease, led to the diagnosis of secondary syphilis.
Mihajlo Petrovski, Olivera Terzieva-Petrovska, Ivona Kovecevska, Ana Minovska, Kiro Ivanovski and Kiro Papakoca
Creating of protocol for the education for oral health and improving oral hygiene among institutionalized elderly is of great significance in prevention of the consequences that can provide numerous oral diseases among the elderly. Activation of as much as possible range of professionals in the field of dentistry in creation of this protocol and the fundamentals for the education of dental staff, and other professionals who care for health also has great significance. In this way with minimal financial loss will be reached maximum benefit-improved quality of life for institutionalized elderly. Taking into consideration the previously mentioned facts about of oral health, the presence of numerous dental problems and increased health needs and poor health among institutionalized elderly the aim of this paper was made- to make a draft protocol for education of the staff responsable for care of the institutionalized elderly aged over 65 years. In this paper are presented fundamentals of a proposed protocol for improving of oral health and hygiene among institutionalized elderly. Presented are all disadvantages in of oral health care for the elderly, are given directions and goals in order for improving of oral health and hygiene among the elderly, guidelines and targets for prevention programs to educate the professionals who care for them.