Syphilis in Saliva

Yes, syphilis can be present in saliva, particularly during primary and secondary stages of infection when oral lesions are present. 1, 2, 3

Transmission and Presence in Saliva

Treponema pallidum (the causative agent of syphilis) can be present in saliva when oral lesions such as chancres or mucous patches are present 2, 3
Primary syphilis can manifest as painless chancres in the oral cavity, most commonly on the tongue, lips, or oropharynx, which contain infectious spirochetes 4, 5
Secondary syphilis commonly presents with highly infectious mucous patches in the oral cavity that can release spirochetes into saliva 1, 6
The oral cavity is recognized as a site commonly affected in early stages of syphilis infection, making saliva potentially infectious during these periods 2

Primary oral syphilis typically presents as a painless, indurated ulcer (chancre) at the site of inoculation, which may appear on the tongue, lips, or oropharynx 3, 4
Secondary syphilis can manifest as multiple mucous patches, erosions, or white patches in the oral cavity 1, 6
Oral lesions of syphilis are often described as "the great imitator" as they can mimic many other oral conditions, leading to delayed diagnosis 2, 6
Oral manifestations may be accompanied by regional lymphadenopathy, particularly submandibular or cervical lymph nodes 5

Darkfield examination and direct fluorescent antibody tests of lesion exudate from oral chancres or mucous patches can definitively diagnose syphilis 1
Serologic testing using both nontreponemal tests (VDRL, RPR) and treponemal tests (FTA-ABS, TP-PA) is essential for diagnosis 1
Biopsy of oral lesions may be necessary in cases where the diagnosis is uncertain or the patient's history is unclear 5
All patients with suspected oral syphilis should be tested for HIV co-infection 1

Oral syphilis lesions are highly infectious, and transmission can occur through direct contact with these lesions during kissing or oral sex 6, 5
Healthcare professionals, particularly dentists, play a crucial role in recognizing oral manifestations of syphilis 2
The increasing incidence of oral syphilis in recent years highlights the importance of considering this diagnosis in patients with unusual oral ulcerations 2, 6
Early recognition and treatment of oral syphilis is essential to prevent progression to later stages and to reduce transmission 1, 5

The recommended treatment for primary and secondary syphilis, including oral manifestations, is benzathine penicillin G 2.4 million units IM in a single dose 1
For patients allergic to penicillin, alternative regimens include doxycycline 100 mg orally twice daily for 14 days 7
Follow-up with quantitative nontreponemal tests at 3,6, and 12 months is recommended to ensure adequate treatment response 1
Sexual partners should be evaluated and treated appropriately 1