2-36. GONORRHEA
Normally a sexually-transmitted disease, gonorrhea is caused by the gram-
negative diplococcus, Neisseria gonorrhoea. Primary infection is by genital contact and
secondary infection is possible via the hands.
2-37. SYPHILIS
a. General. Syphilis is a sexually transmitted disease caused by a spirochete
called Treponema pallidum. Oral lesions often are not present with syphilis. However,
an active lesion or infective blood may transmit syphilis through a break in the skin or
mucosal surface. All oral health providers should be knowledgeable concerning the
infectious potential of syphilitic lesions and take necessary precautions (routine use of
gloves during treatment, sterilization, and so forth). Syphilis can be classified as
acquired and congenital.
b. Primary Syphilis. Acquired syphilis has three stages--primary, secondary,
and tertiary. The first stage of syphilis is characterized by the appearance of a lesion
called the chancre (primary lesion). The chancre is highly infectious and may appear
anywhere on the body. Although it is commonly found on the genitalia, its appearance
in the mouth is not rare (the site of possible oral-genital contact). A chancre in the oral
cavity is characterized by a lesion with a hard, rolled border. Since it is usually painless,
the patient is sometimes unaware of its existence. Usually, it is a solitary lesion. Any
hard lesion appearing on the lips or in the mouth should be viewed with suspicion. The
dentist and the dental specialist should never overlook the possibility of its presence
and the attendant danger of infection. The primary lesion will heal spontaneously but,
unless treated, will progress to secondary syphilis.
c. Secondary Lesions. The second stage of syphilis appears from 3 to 8
weeks after the appearance of the primary lesion. Treponema pallidum enter the
bloodstream at the site of the primary lesion, multiply, and are carried throughout the
body by the circulatory system. Consequently, the secondary lesions may appear
anywhere on the body and in large numbers. The secondary lesions on the oral
mucosa are known as mucous patches. The mucous patch is usually oval in shape with
a moist, glistening, grayish-white, slightly-raised surface. Other secondary lesions may
have a radically different appearance. This makes the clinical diagnosis of secondary
syphilis difficult. As with the primary lesion, mucous patches are highly
contagious. The dental officer and his assistants must be suspicious of any lesions of
the mucous membranes of the mouth and throat and should obtain a laboratory
diagnosis.
MD0511
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