1) PRIMARY STAGE

Development of chancre at site of inoculation. Usually Solitary in nature.

Intra-orally,

➡️ The chancre is an ulcerated lesion covered by grayish white membrane, painful due to secondary infection.

➡️ Sites:

• Lips (Brownish crusted appearance)
• Tongue
• Gingiva
• Palate
• Tonsils
• Fresh Extraction Wound

Microscopically:-

• Superficial Ulcer
• Intense inflammatory infiltrate – Plasma Cells
• Silver Stain – Demonstration of Micro-organisms

Heals: 3 weeks – 2 months

2) SECONDARY/METASTATIC STAGE

• 6 weeks after primary lesion
• Diffuse eruptions on mucous membrane.
• Multiple, painless, grayish white plaques overlying an ulcerated surface.
• Mucous Patches:

• Site: Tongue, Gingiva, Buccal Mucosa
• Highly infectious
• Appearance: Ovoid, irregular & surrounded by erythematous zone.

3) TERTIARY/LATE SYPHILIS:

• Characterized by formation of GUMMA
• Site: Tongue, Palate
• Appearance: Firm, Nodular mass in the tissue; Ulcerates➡️ Deep painless ulcer
• Lesions of Palate cause perforation by sloughing of Necrotic Mass of tissue.

ATROPHIC/INTERSTITIAL GLOSSITIS

➡️ Most characteristic & important lesion of syphilis due to endarteritis obliterans.

➡️ In syphilitic glossitis, the surface of the tongue gets broken up by fissures due to atrophy.

• Males affected
• Fibrosis
• Hyperkeratosis
• Carcinomatous transformation – Epidermoid Ca.

LEUKOPLAKIC INVOLVEMENT

White patches on tongue – Tertiary Syphilis

Due to vasculitis & endarteritis, there’s circulatory deficiency to the lingual papillae

⬇️

Atrophy of filiform & fungiform papillae

⬇️

Bald, smooth, lingual surface

⬇️

Leukoplakic involvement (Dysplastic type)

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References: Shafer’sTextbook Of Oral Pathology, Image source: Google