Sexually transmitted diseases and oral health

STDSexually transmitted diseases are on the increase, despite the best efforts of health professionals in educating the public and creating awareness. Venereal disease, like almost all diseases that affect humans, have an oral manifestation symptoms present in the mouth. A dentist during a routine examination of the mouth could easily pick signs of these and make diagnosis of a more sinister disease.
Certain individuals due to their sexual practice may be at greater risk of contacting sexually transmitted disease, most especially the promiscuous and the young adventurous promiscuous adults and homosexuals. This last group are existing in our community despite the abhorrence and the promulgation of decrees. Promiscuous heterosexuals , drug addicts , prostitutes, alcoholics, armed forces members for obvious reasons, merchant seamen, aircrew, frequent business travellers, and the sexual partners of members of the group above. The List is by no means exhaustive; these diseases are contagious and mainly contactable by intimate and not ordinary contact. This is through body fluids, blood and other body fluids, not by airborne route nominally.
A couple of venereal diseases will be examined in this series.

Syphilis
The disease has a long history, referred to as the gentleman’s disease in the past; it has been off radar in the past until recently.
The organism that causes it is referred to as treponema pallidum. The damage resulting from the infection with syphilis can be extensive,affecting a wide range of organs from the heart to the nervous systems. It has varying presentations depending on the progress of the disease, specified as stages.
Primary, secondary, tertiary and congenital syphilis

Primary syphillis
The period between infection and symptoms appearing is between ten and ninety days with an average of three weeks.
The first visible symptom is a painless sore, swelling, firm pink, called chancre.
The chancre is seen on the glans of the penis and the mucous membrane like the lips and tongue, this swelling quickly ulcerates, this ulcer is painless and is associated with swellings of the glands of the neck cervical lymphadenopathy.
A few laboratory tests help diagnose the condition using swabs; antibodies to the organisms are a better diagnostic tool. Swabs taken from lesions are taken for microscopy culture and sensitivity.
It is noteworthy that the fact that the test is negative at this stage is not  all –clear that there is no disease or infection. Hence a negative test may not necessarily rule out syphilis.

Secondary stage
If the condition diagnosed at the primary stage is not treated, it progresses within six weeks and eight weeks.
The symptoms are mostly a rash headache malaise fever, papules on papules and oral symptoms including ulcers called snail track ulcers. A descriptive term used is the snail track ulcers. Blood tests are positive at this stage, if this is also left untreated at this stage it progresses to the tertiary stage. This happens in at least thirty percent of the affected people.

Tertiarry syphillis
The lesions in the mouth are called gummas, the sizes varies. The gummas can break down to form ulcer, they are seen in the mucous membranes and skin too. The gummas may perforate the underlying bone like the roof of the mouth, the palate. The gummas could also destroy tongue tissue; other bones in the body such as the tibia of the leg, skull bones are also affected.
The lesion is called leukoplakia, it may occur in the tongue, it could be pre- cancerous.
Syphilis could affect the heart vessels which become inflamed especially the big vessel leaving the heart, the aorta. Aortitis and aneurysms, aortic stenosis , the narrowing of the vessels.
A late complication is the invasion of the nervous system which is called neuro syphilis resulting in deafness.

Congenital syphillis
Pregnant women may transmit syphilis to their foetus leading to mental retardation , deafness, saddle nose and oral symptoms affecting the teeth. front teeth become notched called Hutchinson’s incisors teeth, become screw driver shaped and the posterior teeth called mulberry molars.
The incidence of congenital syphilis is quite low because pregnant women are routinely screened for syphilis amongst many other disease with a non specific tests such as the VDRL, venereal disease research laboratory which is positive for all disease with treponema infections such as yaws ,bejel, pinta. Therefore a positive test for VDRL is not necessarily a sign of infection with syphilis. A result that is positive without the presence of the disease is called false positive.
Immunisations can cause a false positive test, similarly other connective tissue diseases.
Venereal disease can be avoided by avoiding high risk activity  such as orogenital sexual and unsafe sexual practices