Symptoms of throat syphilis, diagnosis and treatment

Manifestations of syphilis in the mouth during the primary period of the disease

With primary syphilis, ulcers appear at the site of pathogen penetration - hard chancre (hard ulcers, primary syphilomas). The reason for their occurrence in the mouth is the transmission of infection through sexual perversion, less often - kissing a patient, using infected dishes and personal hygiene items, wind instruments and smoking pipes. Hard chancroid can appear on the mucous membrane of the lips, tongue and tonsil, less often on the gums, mucous membrane of the hard and soft palate, pharynx and larynx.

Hard chancre (primary syphiloma) forms 3 to 4 weeks after the initial infection. Its size is 1 - 2 cm in diameter. There is no pain or other subjective manifestations of the disease. Single erosive chancres are more common. They have a smooth shiny surface, bright red color, round or oval shape. The compaction at the base is less pronounced.

Hard ulcerative chancres are more common in individuals with severe concomitant diseases and reduced immunity. They have a deep defect in the center - an ulcer and pronounced compaction at the base. The bottom of such an ulcer is covered with a dirty yellow coating, and there is copious discharge. Often small hemorrhages form at the bottom.

Rice. 2. In the photo there is syphilis of the tongue in the primary period of the disease - chancre on its lateral surface.

How can you get infected with syphilis of the pharynx?

Treponema pallidum
The causative agent is Treponema pallidum. These are pathogenic bacteria that look like a microscopic corkscrew with their long, thin, spiral-shaped body. They are contained in the biological fluids of sick people and can penetrate the body of healthy people mainly after kissing and unprotected oral sex with an unfamiliar or unfamiliar partner. But it is also possible, although to a much lesser extent, to become infected through household means when using toothbrushes or utensils shared with a sick person:

cups;
glasses;
forks;
spoons;
plates,

if there is any saliva left on them. There is a possibility of contracting syphilis in the throat during dental procedures. There is also a form of congenital syphilis of the throat in infants, which they contract from their sick mothers during pregnancy or breastfeeding. But this type of disease does not pose any particular danger, as it can go away on its own.

Also, patients with secondary syphilis may develop syphilitic lesions of the pharynx and larynx. In this case, it is only a manifestation of the spread of the disease throughout the body and is not associated with the point of infection of the patient.

After Treponema pallidum penetrates the body through microdamages in the mucous membranes of the mouth and pharynx, the incubation period of syphilis begins. This time usually passes without symptoms, so the infected person does not even suspect what is happening in his body. He lives an ordinary life, which he led before, and does not know that he is already affected by the infection. Only when the incubation period (from 0.5 to 6 months), but on average 1 month, has passed, certain symptoms characteristic of the primary period of syphilis will appear.

Syphilis of the throat and larynx has a number of characteristic features that distinguish them from other types of the disease. The differences can be explained by the fact that the pharynx and oral cavity contain conditionally pathogenic saprophytic microorganisms that can become infected with Treponema pallidum, so the clinical picture of the disease changes as a result.

Manifestations of syphilis in the mouth in the secondary period of the disease

During the period of generalization of the infectious process in the secondary period of syphilis, secondary syphilides appear on the mucous membranes of the oral cavity - rashes in the form of roseolas and papules. The mucous membrane of the tongue, cheeks, soft palate, palatine arches, tonsils are the main places of their localization.

Syphilitic roseola in the oral cavity is localized on the tonsils and soft palate and appears as a bright red spot. When roseola merge, large areas of hyperemia are formed, sharply delimited from the surrounding tissues. The general health of the patients remains satisfactory.

Papular syphilides in the oral cavity (dense elements) have a round shape and dough-like consistency, they have a dense base and clear boundaries, they are bright red in color, painless. Constant irritation leads to the appearance of erosion papules on the surface. Papules are most often located on the mucous membrane of the gums, cheeks, along the edges and on the tip of the tongue, in the corners of the mouth, less often - on the mucous membrane of the nose, pharynx, hard palate, vocal cords, epiglottis and eyes.

Erosive-ulcerative syphilides often appear on the soft palate and tonsils.
Papules located in the corners of the mouth resemble jams.
Papules located on the back of the tongue look like bright red, oval-shaped formations with a smooth surface - devoid of papillae (“mown meadow symptom”).
Papules localized on the vocal cords lead to hoarseness and even complete loss of voice.
Papular syphilide of the nasal mucosa occurs as a type of severe catarrhal inflammation.

Papules should be distinguished from bacterial tonsillitis, lichen planus, diphtheria, aphthous stomatitis, flat leukoplakia, etc.

Rashes in the oral cavity due to secondary syphilis are extremely contagious.

Pustular syphilide on the oral mucosa is rare. The developed infiltrate disintegrates, forming a painful ulcer covered with pus. The general condition of the patient suffers.

Rice. 3. Syphilis in the mouth - papular syphilide of the hard palate.

Prevention of syphilis

The risk of infection among family members is reduced by particularly careful adherence to hygiene rules and the absence of any type of physical contact.

General preventive measures are avoidance of sexual relations with unfamiliar partners, or, as a last resort, use a condom; preventive treatment within two hours immediately after contact; examination by a venereologist a few weeks after accidental contact. It is necessary to be examined together with your husband/wife (regular partner), and not to use any self-medication.

Medical workers carry out prevention in the form of:

regular examinations of risk groups (drug addicts, prostitutes);
triple examinations of pregnant women;
preventive therapy for pregnant women who have previously been ill;
information component (lectures for young people, printing of special literature about the dangers of infection).

The sooner a venereologist conducts an examination after a possible infection, the greater the chance of treatment success. You shouldn’t rely on “luck” in such cases; no one is protected from becoming infected after accidental sexual contact.

Manifestations of syphilis in the mouth during the tertiary period of the disease

In 30% of cases during the period of tertiary syphilis, the mucous membranes of the nose, soft and hard palate, tongue and posterior pharyngeal wall are affected. Tertiary syphilides are always few in number, appear suddenly, there are no signs of acute inflammation and subjective sensations. There is often no response from the lymph nodes.

Gummous syphilide of the mucous membrane appears in the form of a small node, which, due to sudden infiltration and swelling, increases in size and acquires a dark red color. The boundaries of the gummous lesion are clear. Over time, the infiltrate disintegrates, soft tissue and bone formations are destroyed, which leads to irreversible deformations and impaired organ function.

The resulting ulcer is deep, has crater-shaped edges, congestive-red color, sharply demarcated from the surrounding tissues, painless, with granulations at the bottom. During healing, a retracted scar is formed.

The disintegration of the gumma located on the hard palate leads to its perforation.
The disintegration of the gumma located in the area of the nasal septum leads to its deformation (“saddle nose”) and perforation of the nasal septum, the integrity of the organ and the function of breathing, swallowing and phonation are disrupted. The resulting perforations do not close during healing.

The rashes of the tertiary period of syphilis are practically not contagious, since they contain a minimal number of pathogens.

Tuberous syphilide is less common. The tubercles most often appear on the lips, soft palate and uvula (vera palatine), hard palate and the mucous membrane of the upper jaw that supports the teeth (alveolar process). The tubercles are dense to the touch, small, prone to grouping, reddish-brown in color, and quickly disintegrate with the formation of deep ulcers. Healing occurs in scars.

Rice. 4. The photo shows the consequences of tertiary syphilis in the mouth - perforation of the hard palate.

Syphilis of the throat and larynx: symptoms, photos, treatment, difference from acute respiratory infections and acute respiratory viral infections

A fairly rare disease - syphilis of the larynx - affects the pharynx, tonsils, hard and soft palates, as well as the larynx itself. It is not difficult to become infected with this disease; it is enough to share the same utensils or personal hygiene products with the patient. Of course, infection also occurs with a kiss.

Etiology

The incubation period of the disease does not have any symptoms. Therefore, all this time the patient does not even suspect that he has contracted syphilis of the larynx.

At the same time, he poses a danger to others, since he is now a carrier of the disease. This may continue for several months. That's when the first signs begin to appear.

The causative agents of the infection are Treponema pallidum.

Syphilis is a sexually transmitted disease. Infection of the larynx occurs when an external source of infection enters the saliva. The primary manifestation of the disease is dirty gray ulcers that have raised edges with a dense cartilage.

With the secondary manifestation, a white coating appears in the form of spots. When a secondary infection occurs, swelling of the larynx, inflammation of its perichondrium and necrosis of the cartilage occur. In this case, perichondritis occurs, in which suppuration of the tissues with the formation of a fistula is possible.

Syphilis of the larynx poses a danger to both the health of the ENT organs and the person himself. It can affect any tissue, atrophying it and leading the patient to disability or death.

The photo shows manifestations of syphilis in the throat

Routes of infection

For the pathogen to enter the body, direct contact with the patient is sufficient. Syphilis can enter through microcuts or cracks in the mucous membrane. Open sores in the mouth or genitals are considered the most contagious. Infection occurs in the following ways:

Oral sex
Kisses
Transfusion of blood from a sick person to a healthy person
Contact household (through devices that may contain saliva: dishes, toothbrush, dental instruments)

Most often, syphilis is contracted through sexual contact with a sick person. The entry route for the pathogen is the oral cavity and upper respiratory tract. Both are covered with a mucous membrane - a medium for the spread of the disease. There is a possibility of intrauterine infection from a pregnant sick mother.

The infectious agents are localized on the lymphoid tissue of the pharynx and larynx, which provokes uncontrollable coughing attacks in the patient.

Syphilis is not accompanied by painful sensations; it develops over a fairly long period. The primary manifestation of the disease is localized to:

Mucous lips
Language
Tonsils
Desna
Mucous membranes of the hard and soft palate
Throat
Larynx

Thus, the entire oral cavity is affected. In this case, hard ulcers are formed - chancres, which after a month reach 1-2 centimeters in size. Their surface is smooth and their color is bright red. The bottom of such formations is covered with plaque.

In the secondary period, damage occurs to the membranes of the cheeks, tongue, tonsils, soft palate and palatine arches. Papules form on them, having a clear round shape. Their irritation provokes the appearance of erosion.

The tertiary period of syphilis of the larynx is characterized by localization on the mucous membranes of the nasal cavity, soft and hard palate, tongue and posterior wall of the larynx.

There are no signs of acute inflammatory process or enlarged lymph nodes.

The resulting ulcers are deep, bright red, different from the surrounding tissues and limited from them, at the bottom they are covered with granulations. Their healing leaves behind a visible scar.

For more information about throat syphilis, watch this video:

Signs and manifestations

The first stage of laryngeal syphilis occurs without visible symptoms. Only a medical examination will help detect it at this stage. If the disease is detected, it is completely by chance, during the diagnosis of other disorders. Symptoms begin to progress in the second stage:

When examining the patient, duplication of the epiglottis and arytenopharyngeal folds covered with wounds may be detected. The epithelial layer of the mucosa becomes bright red with spots that have a round outline and are covered with a white coating.

As the disease progresses, respiratory function becomes impaired. This is facilitated by the growth of ulcers and the appearance of scars. At the third stage, the appearance of red-blue tissue compactions is noted.

They are a mixture of lymph and blood. These compactions will unite into nodes, which may not change their structure for months, and then suddenly disintegrate. In places where they are destroyed, wounds form, which then heal.

Pathogenesis of the disease

First stage

The mucous membrane of the organ through which the infection occurred becomes covered with papules - blisters with clear liquid. Within a week, they harden and turn into chancre, on the surface of which erosions form.

Depending on their manifestation, syphilis can have erymatous, erosive or ulcerative forms. A hard chancre forms on the tonsil, which provokes an enlargement of the cervical lymph nodes.

Literally within a few days, the nodes increase throughout the body.

Second stage

The second stage is characterized by a wave-like flow. The exacerbation is replaced by remission. This is due to the life cycle of the infectious agent. In addition to the rapid spread of the disease through the mucous membranes of other organs, characteristic rashes appear on the skin. Hair loss and headaches may begin.

Third stage

Observed in the absence of treatment for several years. Gummous tumors form in the throat. Their opening is accompanied by the appearance of ulcers covered with necrotic plaque. They are very vulnerable to secondary infections. When they are damaged, an abscess begins. The development of purulent inflammatory processes leads to hearing loss. Voice disturbance and nasal breathing problems.

The difference between laryngeal syphilis and acute respiratory infections or acute respiratory viral infections

In the first or second stage, laryngeal syphilis is often confused by symptoms with respiratory infections. Chancre on the tonsils can be mistaken for a manifestation of unilateral tonsillitis, and the resulting damage to the throat can be taken for laryngitis. The fundamental differences between syphilis and acute respiratory infections are as follows:

With ARVI, there is a significant increase in body temperature; with syphilis, it may not be there or may be slightly increased.
With syphilis, swelling affects both the soft and hard palates, and the mucous membrane has a copper color.
Syphilitic papules have a pronounced red outline, in contrast to the spots characteristic of purulent tonsillitis.
Purulent plaque with sore throat is cured in 1.5 weeks. Ulcers of syphilitic origin do not heal for months.

Another distinctive feature is the manifestation of pain. With syphilis of the larynx it is absent, but with ARVI it is significantly noticeable.

For information about the symptoms of syphilis, watch our video:

Diagnostics

A blood test will help identify the syphilitic origin of the disease. The patient undergoes a Wasserman serological test. An analysis is taken from the mouth and throat to identify the causative agent of the infection - Treponema pallidum. An endoscope is used to examine the larynx.

During diagnosis, the likelihood of developing diseases with similar symptoms (tuberculosis, tonsillitis, leukoplakia) is also checked and excluded. During research, the possibility of the presence of malignant tumors cannot be excluded.

Treatment

The sooner treatment is started, the better results can be achieved. The main thing when choosing therapy methods is to preserve the appearance and functionality of the larynx. Antibiotics are prescribed from medications:

Penicillin series
Macrolides
Cephalosporins

They have a destructive effect on the infectious agent. If the nose is affected, solutions of potassium permanganate or sodium bicarbonate are used to rinse it. You can soften your throat and eliminate dryness by performing inhalations using alkaline-oil solutions. The use of aerosols containing antibiotics is also required.

If the nasopharynx is deformed, perichondritis develops, or an abscess appears, surgical intervention is required.

Auxiliary treatments may include local antiseptics (eucalyptus or chamomile infusions) and a hydrogen peroxide solution for gargling. They do not cure syphilis, but promote the healing of ulcers.

An otolaryngologist, a dermatologist and a venereologist are involved in the treatment of laryngeal syphilis and the prescription of drug dosages. Self-medication during the development of a disease of this nature is life-threatening.

Why is syphilis dangerous?

Forecast

In the absence of destructive pathological complications, the prognosis for recovery for the patient is favorable. The patient's regular sexual partner should also receive examination and preventive treatment.

Source: https://gidmed.com/otorinolarintologija/zabolevanija-lor/bolezni-gorla/sifilis.html

Syphilis on the tongue

The tongue with syphilis is affected in the primary, secondary and tertiary periods of the disease.

Syphilis of the tongue in the primary period of the disease

Hard chancre on the tongue is often single, ulcerative or erosive in nature. Sometimes it has a slit-like shape located along the tongue.

Rice. 5. Syphilis of the tongue in the primary period - chancre. Syphilide is an erosion or ulcer with a dense infiltrate at the base.

Rice. 6. The photo shows a hard chancre on the tip of the tongue.

Syphilis of the tongue in the secondary period of the disease

During the secondary period of syphilis, erosive papules most often appear on the mucous membrane of the tongue - papular syphilide.

Rice. 7. Papules on the tongue are oval in shape, bright red in color, painless and highly contagious.

Rice. 8. The photo shows syphilis of the tongue in the secondary period of the disease. The papules are round, dark pink, single or multiple, devoid of papillae (“mown meadow symptom”).

Rice. 9. Secondary period of syphilis. Papules on the tongue.

Syphilis of the tongue in the tertiary period of the disease

In the tertiary period of syphilis, single or multiple gummas (nodular glossitis) more often appear on the tongue, diffuse (spread) sclerosing glossitis develops less often. Sometimes, isolated gummas appear against the background of sclerosing glossitis.

The gummous infiltrate is large in size (about the size of a walnut), quickly disintegrates with the formation of a deep ulcer and an uneven bottom, surrounded by a shaft of dense infiltrate. The developed scar tissue significantly deforms the tongue.

Sclerosing glossitis is characterized by the development of diffuse infiltration in the thickness of the tongue. The tongue becomes dense, acquires a dark red color, and the mucous membrane thickens. As a result of rapidly developing sclerosis, when muscle fibers are replaced by dense connective tissue, the tongue contracts and becomes smaller in size, its surface is smoothed (loses papillae), becomes bumpy, and becomes significantly denser (“wooden” tongue). There is increased salivation (salivation). Appearing cracks often become infected, which leads to the appearance of erosions and ulcers that are prone to malignancy. The disease occurs with severe pain, the patient's speech is impaired and eating is difficult.

Rice. 10. Syphilis of the tongue in the tertiary (late) period of the disease - a single gumma of the tongue (photo on the left) and a disintegrating gumma (photo on the right).

Syphilis of the tonsils (syphilitic tonsillitis)

Treponema pallidums have a tropism for lymphoid tissue, which is why syphilitic tonsillitis and enlarged lymph nodes are recorded at all stages of the disease.

Syphilis of the tonsils in the primary period

During the period of primary syphilis, chancre is sometimes recorded on the tonsils. The disease occurs in several forms - anginal, erosive, ulcerative, pseudophlegmonous and gangrenous.

In the anginal form of the disease, the primary chancre is often hidden in the submygdaloid sinus or behind the triangular fold. The patient's body temperature rises and moderate pain in the throat appears. The palatine tonsil is hyperemic and enlarged in size. Regional lymph nodes are enlarged.
When an oval-shaped red erosion with rounded edges, covered with gray exudate, appears on the tonsil, they speak of an erosive form of tonsil chancre. The bottom of such erosion has a cartilaginous structure.
In the ulcerative form, a round ulcer appears on the palatine tonsil. At its bottom there is a film that is gray in color (syphilitic diphtheroid). The disease occurs with high body temperature, sore throat radiating to the ear on the affected side, and increased salivation.
The pseudophlegmonous form of the disease occurs as peritonsillar phlegmon. Massive doses of antibacterial drugs significantly improve the patient’s condition, but the syphilitic process continues.
In the case of the addition of a fusospirile infection, a gangrenous form develops. The disease is characterized by the development of a septic process and gangrene of the tonsil.

A long course and lack of effect from symptomatic treatment are characteristic signs of primary syphilis of the tonsils - chancre-amygdalitis.

Rice. 11. In the photo there is syphilis of the tonsils - chancre-amygdalitis, ulcerative form.

Rice. 12. In the photo, the anginal form of the disease is chancre-amygdalitis of the right tonsil. A characteristic feature is the characteristic copper-red color of the tonsil and the absence of inflammation of the surrounding tissues.

Syphilitic tonsillitis of the secondary period of the disease

With secondary syphilis, secondary syphilides - roseola and papules - may appear on the soft palate, tonsils and arches.

Roseola (spots of hyperemia) during the disease are located either isolated or can merge and form large areas of hyperemia. The lesion is called erythematous syphilitic tonsillitis. Roseolas are red in color and sharply demarcated from surrounding tissues. The patient's condition remains satisfactory.
When papules appear on the tonsils and the area of the lymphoid ring, they speak of papular syphilitic tonsillitis . Papules merge to form plaques. The rashes have clear boundaries. With constant irritation, the papules become ulcerated and covered with a whitish coating, pain appears when swallowing, the temperature rises, and the general condition of the patient worsens.

Rice. 13. In the photo there is syphilis in the mouth. On the left is syphilitic erythematous tonsillitis, on the right is papular tonsillitis.

Rice. 14. The photo shows erythematous syphilitic tonsillitis.

Syphilis of the tonsils in the tertiary period of syphilis

In the tertiary period of syphilis, gumma may appear on the tonsil. The disintegration of gumma leads to complete destruction of the organ and surrounding tissues. Cicatricial deformation of the pharynx leads to the development of severe atrophic pharyngitis.

Syphilis of the hard palate

With primary, secondary and tertiary syphilis, the hard palate can be affected. Gummas of the hard palate can affect not only the mucous membrane, but also spread to the bone structures of the organ, which leads to their destruction and perforation.

Syphilis of the hard palate in the primary period of the disease

Primary syphiloma (chancroid) on the hard palate appears 3 to 4 weeks after infection. With ulcerative chancre, a hard infiltrate is located at the base. In the case of the formation of a deep ulcer, the infiltrate at the base acquires a cartilage-like structure. With erosive chancre, the infiltrate at the base is barely noticeable and weakly expressed. Even without treatment, after 4 to 8 weeks, the ulcer and erosion scars on its own. Scarring occurs much faster under the influence of specific treatment.

Rice. 15. Syphilis in the mouth. Primary syphiloma of the hard palate.

Syphilis of the hard palate in the secondary period of the disease

With secondary syphilis, papular syphilides more often appear on the mucous membrane of the hard palate. They are dense, flat, round, smooth, red, located on a dense base, with clear boundaries, painless. Frequent irritation leads to the appearance of areas of maceration on the surface, and sometimes papillary growths. As papules grow, they merge.

Rice. 16. Syphilis in the mouth - papules on the hard palate and tongue (photo on the left) and papules on the hard palate (photo on the right).

Syphilis of the hard palate in the tertiary period of the disease

When gumma is located on the hard palate, the disease is tragic. Due to the thin mucous membrane, the gummous process quickly spreads to the periosteum and bone. When gumma disintegrates, the bone quickly becomes necrotic and sequestra (dead areas) appear. As a result of perforation, a communication occurs between the nasal cavity and the mouth, which leads to difficulty eating and speech impairment.

Rice. 17. Gummous infiltration of the hard palate (photo on the left) and gummous infiltration (photo on the right).

Rice. 18. The photo shows the consequences of tertiary syphilis - perforation of the hard palate.

Diagnosis of syphilis

Diagnosis of a disease such as syphilis of the throat can be easy in one case, if the attending physician initially noticed the formation of chancre.

But, unfortunately, lack of experience in diagnosing syphilides often leads to incorrect diagnosis. Doctors may confuse chancroid with a tuberculous ulcer and many different peptic ulcers that develop in the tonsils.

To successfully diagnose the primary stage of laryngeal syphilis, you need to undergo a serological test. Also, the patient is sent to take tests for the presence of Treponema pallidum in the mouth and throat.

Diagnosing syphilis in the throat in the secondary period is not an easy task. This disease is easily confused with a host of other diseases, for example, with various types of sore throat, leukoplakia, herpes, tongue disease (tuberculosis, malignant tumors) and other diseases.

An important sign for diagnosing syphilitic lesions of the throat is that the inflammatory process spreads along the edges of the palatine arches or the soft palate.

To accurately determine syphilis, you need to conduct a serological test for all diseases of the mucous membrane of the oral cavity and pharynx.

In the third period, syphilis can be easily confused with throat cancer and tuberculosis. To exclude this type of disease, the patient is referred for a lung x-ray and biopsy.

Syphilis of the soft palate

The soft palate (vera palatine) is often affected along with the hard palate in tertiary syphilis. Gummas may appear on it, but gummatous infiltration occurs more often. The affected areas have a rich purple color and lead to stiffness of the soft palate. As a result of cicatricial changes, atresia (fusion) of the pharynx occurs. The soft palate fuses to the back of the oropharynx, causing the oral and nasal cavities to separate. Organ function is impaired.

With the development of tubercular syphilide, isolated elements are formed on the soft palate, the breakdown of which forms ulcers that heal with scars. Scar tissue leads to deformation of the organ.

Rice. 19. Damage to the soft palate (schematic representation).

Treatment

Penicillin series
Macrolides
Cephalosporins

If the nasopharynx is deformed, perichondritis develops, or an abscess appears, surgical intervention is required.

Auxiliary treatments may include local antiseptics (eucalyptus or chamomile infusions) and a hydrogen peroxide solution for gargling. They do not cure syphilis, but promote the healing of ulcers.

Why is syphilis dangerous?

Syphilis of the throat: damage to the pharynx

The pharynx is the initial part of the digestive tract and respiratory tract. It connects the nasal cavity and the larynx, the vocal organ.

Damage to the pharynx in primary syphilis

With primary syphilis, unilateral lesions are more often observed. Chancre can be erythematous, erosive or ulcerative. Treponema pallidum has a tropism for lymphoid formations of the throat. Their defeat leads to the appearance of an indomitable cough. With the disease, regional lymph nodes always enlarge.

Damage to the pharynx with secondary syphilis

The pharynx in secondary syphilis is often affected along with the larynx. At the same time, skin rashes appear on the patient’s skin—secondary syphilides.

Damage to the pharynx in tertiary syphilis

In tertiary syphilis, damage to the pharynx occurs in the gummous form, diffuse and early ulcerative-serpentiform forms.

The gummous infiltrate does not manifest itself in anything until ulceration appears. When gumma disintegrates, bleeding may occur and the bones of the spine and skull may be destroyed. As a result of the development of scar tissue, communication (partially or completely) between the nasal and oral cavities is disrupted. Breathing becomes possible only through the mouth, the voice changes, taste and smell disappear.
In the diffuse syphilomatous form, multiple lesions are observed on the mucous membrane of the pharynx. At the beginning of the disease, the changes are in the nature of hypertrophic pharyngitis. But then an extensive syphilitic ulcer is formed, similar to carcinoma.

Features of throat damage with syphilis

Syphilitic chancre in the pharynx is more often observed in women than in men. It is difficult to notice a chancre during a self-examination or during an examination in a doctor’s office. You can see it only if you lift the tongue. In addition to the pharynx, chancre can be located on:

Gums. If a patient has gum pain, he often goes to the dentist, who may not always suspect syphilis. Chancre often looks like periolar periostitis or bright red erosion covering the neck of one or more teeth.
Tonsils. During primary infection, one tonsil appears in the affected area. It increases in size and turns red. A plaque, erosion or ulcer develops on the tonsil.
Language. Chancre most often occurs on the back of the tongue and can have a sclerotic, erosive, slit-like or ulcerative form.
Lips. Primary syphiloma on the lips may be covered with a brown crust. A chancre on the lip persists for several weeks. Due to constant irritation, swelling or inflammation may develop. This leads to the addition of a secondary infection.

The average duration of the incubation period of the disease is 20 days. However, if the patient’s body is weakened by any diseases, this period can be shortened to 10 days. The disease can be asymptomatic for 60-90 days. This situation is typical in cases where the patient took antibiotics before infection or continues to take them after infection. The drugs cannot completely destroy Treponema pallidum, but they also do not give it the opportunity to multiply quickly.

The external manifestations of the disease depend on the patient’s age, his state of health and the form of the disease:

Anginous. This form resembles a sore throat in its symptoms. The patient experiences discomfort in the throat and pain when swallowing, feels apathy and weakness. The temperature can rise to 38ºС.
Ulcerative. Ulcers are numerous rashes with gray fluid inside. They are located in the tonsil area.
Gangrenous. With this form, small granules appear on the tonsils. Possible increase in temperature. The patient feels weak. Putrefactive processes begin in the lymphoid tissue.
Pseudophlegmonous. The signs are similar to peritonsillar phlegmon, which complicates diagnosis. It is possible to detect syphilis only at the second stage of the disease.
Erosive. In the erosive form, the course of the disease is one-sided.

Syphilis of the throat: damage to the larynx

The larynx is the upper part of the respiratory system and the organ of voice production. It is located in the front of the neck, where the Adam's apple (thyroid cartilage) is formed.

Damage to the larynx in secondary syphilis

With secondary syphilis, the appearance of roseola or papular rashes on the vocal cords is noted, which leads to syphilitic dysphonia (violation of the sound of the voice) or aphonia (complete absence of voice). Diffuse erythema is similar to catarrhal laryngitis. Since secondary syphilides in the larynx do not show themselves for a long time, the disease goes unnoticed at first, and the patient all this time poses a danger to others.

Damage to the larynx in tertiary syphilis

During the period of tertiary syphilis, gummas may appear in the larynx. When they disintegrate and a secondary infection occurs, inflammatory swelling appears, which leads to difficulty breathing. The ulcer, when the gumma disintegrates, has crater-shaped, sharply defined edges, is dense, with a greasy bottom. When the gumma is located on the epiglottis, the presence of a foreign object in the throat is felt. With large infiltrate sizes, laryngeal stenosis develops. Scarring of syphilitic ulcers located on the vocal folds and when the arytenoid cartilages are damaged, the voice becomes hoarse forever, sometimes aphonia develops (complete loss of sonority of the voice). Soreness is often absent or insignificant.
With the development of a diffuse gummous infiltrate, the lesion affects the superficial layers of the organ, sometimes deep, when the pathological process passes to the muscle layer and perichondrium. The site of infiltration has the appearance of reddish-yellow thickenings with an inflammatory rim along the periphery, often extending to the epiglottis, or ligamentous apparatus, or subglottic region. With ulceration, the surface of the diffuse gummous infiltrate becomes uneven.

Treatment of syphilis of the larynx and throat

Syphilis of the throat is a chronic infectious disease, one of the forms of syphilis that affects the pharynx, larynx, tonsils, soft and hard palate. The causative agent of the disease is Treponema pallidum (a type of bacteria). Syphilis is a sexually transmitted disease, since the main route of transmission is sexual. However, infection is possible through other routes.

Syphilis is a dangerous disease that is difficult to treat, especially in advanced cases. Syphilitic lesions of the throat threaten not only the health of the ENT organs, but also human life in general.

Treponema pallidum is dangerous because it can affect almost any tissue of the body. The most dangerous consequence of infection is neurosyphilis - damage to the nervous tissue, which can lead to disability and death.

Thus, if you suspect syphilis, you should consult a therapist or venereologist as soon as possible. We will tell you exactly what symptoms should alert you and prompt you to visit a doctor.

The article will also help you learn about modern methods of diagnosis and treatment of syphilis of the larynx and pharynx.

Transmission routes

Treponema pallidum can be transmitted from person to person through microscopic cracks in the mucous membranes. Thus, for infection to occur, direct contact with a person who already has syphilis is necessary. It is known that the most contagious, i.e. contagious, patients with primary syphilis are those who have open ulcers on the mucous membranes (in the mouth, on the genitals, etc.)

Syphilis infection of the throat can occur when:

oral sex;
kisses;
blood transfusion from a sick person to a healthy one;
using dishes and other items on which the patient’s saliva remains.

The predominant route of transmission of Treponema pallidum is sexual. However, it is believed that it is possible to become infected through household means, for example, by using shared utensils. Many experts doubt this possibility. The fact is that outside the human body, Treponema pallidum dies quite quickly. That is why the transmission of syphilis through household objects is unlikely.

Syphilis of the larynx and pharynx usually develops when the entry point for infection is the oral cavity or upper respiratory tract.

In addition, syphilitic lesions of the throat can develop in patients with secondary syphilis (in this case, the lesion is secondary and is not related to the route of infection). Intrauterine infection of the child is also possible if the pregnant mother is infected.

Stages of disease development

The incubation period of the disease lasts from 2 to 6 weeks. All this time, the infection develops unnoticed by the person. The carrier may not be aware of the fact of infection and put the health of loved ones at risk.

On average, 3 weeks after infection the first symptoms of the disease begin to appear. Syphilis then develops according to the following pattern (if untreated):

A red spot forms on the mucous membrane of the organ through which the infection occurred, and then a papule (a blister filled with a clear liquid). Within a week, the papule transforms into a hard chancre. Chancroid, also called primary syphilide, is a round, raised lesion that is bright pink in color. Erosion forms on the surface of the chancre. Depending on the type of erosion, erymatous, erosive and ulcerative forms of primary syphilide are distinguished. With syphilitic lesions of the throat, a hard chancre forms on the tonsil (usually on one side), or on the epiglottis or pharyngeal mucosa. Within a week after the formation of a hard chancre in the throat, the lymph nodes located in the neck enlarge. This symptom is also characteristic of various tonsillitis, which makes it difficult to diagnose throat syphilis in the early stages. However, after a few more days, the active reproduction of Treponema pallidum causes a violent immune response, as a result of which the lymph nodes enlarge throughout the body, which is not typical for tonsillitis.

About a month to a month and a half after formation, the chancre spontaneously heals. At this stage, the patient may decide that he has been cured (especially if he has taken any therapeutic measures, for example, gargling with antiseptics). The danger lies in the fact that antiseptics do not affect the development of syphilitic infection.

Healing of chancre is not associated with an improvement in the patient's health. The infection continues to progress.

The second stage of syphilis has a wave-like course. Stages of exacerbation are replaced by stages of remission. During remission, syphilis is asymptomatic. Such fluctuations are associated with the life cycle of Treponema pallidum (each exacerbation corresponds to the reproduction period of Treponema). Secondary syphilides are called papule-like lesions of the mucous membrane that appear some time after the healing of chancre. Secondary syphilides can affect large areas of the mucous membrane, spreading to the pharynx, larynx, and nasal cavity. At the same time, a characteristic symmetrical rash appears on the patient’s skin. Many patients also complain of headache, severe weakness, fever, and hair loss.
Tertiary syphilis is observed in very advanced cases if the patient has not received proper treatment for years. With syphilis of the throat of the third stage, patients are found to have so-called gummous tumors - formations in the form of hemispheres, filled with soft contents. When opened, gummous tumors form ulcers with an uneven “ragged” edge, covered with necrotic plaque. They can be localized on the hard and soft palate, epiglottis, and less often in other areas. Ulcers are vulnerable to secondary infection, including opportunistic microflora of the pharynx. When a secondary infection occurs, an abscess may form in the throat. Purulent inflammation can affect the ligaments and cartilages of the larynx. As a result of subsequent disorders, the patient’s voice, hearing, and nasal breathing may be impaired.

Syphilis of the larynx and throat is treated at any stage. Naturally, primary syphilis is best treated. If treatment is started at the third stage, complications are possible, since healing ulcers form scars. Scarring of the mucous membrane of the pharynx and larynx can cause loss of voice and impair breathing.

How to distinguish syphilis of the throat from acute respiratory infections?

Primary and even secondary syphilis can be mistaken for common acute respiratory infections (ARIs) affecting the throat. For example, a hard chancre on the tonsil resembles unilateral tonsillitis (especially Vincent's necrotizing tonsillitis), and syphilitic lesions of the larynx do not differ in external symptoms from ordinary laryngitis.

Let us highlight the key differences between syphilis in the throat and acute respiratory infections:

With syphilis, the body temperature is slightly elevated, unlike sore throat and many ARVIs.
Pain when swallowing is moderate, and often completely absent.
Swelling of the mucous membrane with syphilis spreads to the soft and hard palate; the mucous membrane has a copper tint.
Syphilitic papules on the mucous membrane are the key difference. Along the edge they are surrounded by a red border (unlike spots of purulent plaque with sore throat).
Papules can be found not only on the tonsils, but also on the tongue, soft palate, and buccal mucosa.
With adequate treatment of sore throat, purulent plaque in the throat disappears within 10 days, while syphilitic lesions may not heal for a month or more.

Clinical diagnosis

Modern diagnosis of syphilitic infection is based on blood tests. All methods for detecting syphilis can be divided into treponemal and non-treponemal. The difference is that treponemal tests are aimed at detecting antibodies to treponema, while non-treponemal tests judge the presence of infection indirectly, by characteristic changes in clinical and biochemical blood parameters.

Non-treponemal tests are more accessible, so they are most often used in clinics. These include RPR, RW with cardiolipin antigen. Please note that non-treponema tests may produce a false-positive result (ie, the test indicates the presence of treponema when the patient does not have this infection).

Positive results from nontreponemal tests must be confirmed by treponemal blood tests.

Treponemal tests include RIF, RIBT, RW with treponemal antigen. They are used to diagnose syphilis, but not to monitor treatment. Once infected with syphilis, treponemal tests remain positive for life.

Quantitative non-treponemal tests are used to assess the effectiveness of syphilis treatment.

Treatment of syphilis

When treating syphilis, it is necessary to abstain from sexual intercourse until recovery. If the patient has a regular sexual partner, he should also be examined and receive the necessary treatment.

To cure syphilis, you need to destroy its cause - Treponema pallidum. Antibiotics are used for this purpose. It is known that this microorganism is sensitive to the action of such a common antibiotic as penicillin.

Other antibiotics are used less frequently - macrolides or cephalosporins (their choice is made if the patient is suspected of having an allergy to penicillin). The drugs and their doses are prescribed by a venereologist.

Self-medication for syphilitic throat lesions is inappropriate and dangerous.

Local treatment does not affect the viability of Treponema pallidum and is not able to cure syphilis. Rinsing only speeds up the healing of ulcers on the mucous membrane.

Oksana Tsiklauri

Sources: medscape.com, health.harvard.edu, medicalnewstoday.com.

Source: https://globalmedclub.ru/bolezni-gorla/virusy-i-infekcii/sifilis-glotki-i-gortani.html