Inherited Syphilis

This may appear in the form of coryza (snuffles) beginning in the first 3 months

of life. It is characterized by an obstinate nasal discharge which tends to dry

up and form crusts, while the irritation of the secretion causes fissures to

appear at the anterior nares. At a later stage, usually at puberty but sometimes

not until adult life, gummatous ulceration may destroy the tissues and lead to

atrophy and scarring, so that the bridge of the nose is depressed and foetid

crusts form within the nasal cavity. The permanent teeth and the cornea show the

well-known defects. In infants so affected other evidence of the disease should

be looked for and the family history must also be investigated.

Acquired Syphilis

Primary infections of the nose are very rare. Secondary lesions in the form of

mucous patches are met with less commonly than in the pharynx, and only slight

symptoms are produced. In its tertiary form syphilis may occur in the nasal

cavities. The septum is most commonly involved, but the lateral wall of the nose

may also be affected. The stage of gummatous infiltration is rarely seen

because, as a rule, ulceration and destruction of tissue have taken place before

the patient is examined. The gumma takes the form of an irregular mamillated

Infiltration, dark red in colour, involving one or both sides of the septum.

Usually at this stage the only symptom is nasal obstruction, but there may be

headache and severe pain in the nose, which may be swollen and tender. When

ulceration occurs it is accompanied by a purulent discharge which tends to dry

and form crusts which emit a horrible stench. After removal of the crusts by

douching, the nose may be more fully inspected. If the septum is affected it

will be found to be perforated, and the perforation usually involves the bony

structures as well as the cartilaginous portion. If the process is still active

the edges of the perforation will be covered with granulations. The loss of

tissue may be so extensive that there may be sinking of the bridge of the nose

and even ulceration and destruction of the external nose. The structures of the

lateral wall of the nasal cavity may also be extensively ulcerated and in part

destroyed.

Diagnosis. When a granular lesion, especially one associated with foetid crusts,

Is found on the nasal septum syphilis should be suspected. The diagnosis is made

on serological testing.

Treatment. Penicillin is the treatment of choice. The nose should be kept clean

by frequent douching, and all loose sequestra should be removed.

Syphilis of the Pharynx

Primary syphilis is uncommon, but the tonsil is second to the lip as the

frequent extragenital site. The chancre is unilateral, persists for several

weeks and is accompanied by enlarged cervical glands. Palpation by a gloved

fingers will disclose that the lesion is of cartilaginous hardness. The

discovery of Treponema pallidum may confirm the diagnosis.

Secondary syphilis in the pharynx is much more common and much more important in

that it is most contagious because the lesion teems with spirochaetes. Initially

there is congestion of the palate and fauces, and some tonsillar enlargement,

but soon the mucous patch develops. This may be found on any part of the mucosa

of the mouth or pharynx, the principal sites being, in order of frequency, the

tonsil, the palatine arches, the tongue and the inner aspect of the lips. The

patch is round or oval, bluish-grey in colour with a surrounding zone of

congestion. The patches may be multiple and symmetrical, and may become

confluent. Ulceration takes place, leaving a snail-track ulcer of a dirty grey

colour. The cervical glands are enlarged, and there may be a skin eruption.

Tertiary syphilis does not appear as a gumma for some years after the initial

infection. A hard purplish swelling appears on the palate, posterior between the

epiglottis and the tongue, and so be overlooked unless a breaks down at its

centre to form a punched-out ulcer with a greenish-yellow base and red,

indurated edges.

Postsyphilitic complications are much less often seen now. They were prone to

follow hereditary syphilis when they appeared about the age of be considerable

cicatricial stenosis of the pharynx.

Symptoms. The chancre may not cause any symptoms. Secondary lesions cause only

slight pain in the throat, although some dysphagia may be felt when ulceration

takes place. Pain is rare in the tertiary lesions, and the patient may only

complain of a nasal speech or of food entering the nose while eating.

Diagnosis. It must be made from other lesions causing ulceration or membrane

formation. The primary and secondary stages are usually recognized, but the

gumma may be confused with Vincent’s infection or with carcinoma. Serological

tests and a biopsy will generally decide the question. Lupus also causes

destruction of the pharyngeal mucosa, but is more slow and is associated with

skin nodules.

Treatment. Treatment is that of syphilis, and should be undertaken by a