The characteristics of men who have sex with men presenting with oral syphilis: a systematic review.
Amber Savary-Trathen, Zoe Constantinou, Harry Horton-Hill et al.
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In 30 seconds
This systematic review described demographic, behavioural, co-infection and clinical features of men who have sex with men (MSM) presenting with oral syphilis. Searches of four databases identified 34 manuscripts reporting 47 MSM; median age was 29 years (IQR = 26-37). Reported features included varied sexual behaviours and co-infections, while oral lesions differed in pain, site and presence of lymphadenopathy. Seventeen men underwent biopsy and histological examination during investigations for malignancy that the review characterised as unnecessary. The findings highlight the varied presentation and potential for oral syphilis to prompt malignancy work-up.
Key findings
- The review included 34 manuscripts describing 47 MSM with oral syphilis; median age was 29 years (IQR = 26-37).
- Reported clinical presentations included painful or painless lesions on the tonsils, lips, tongue or buccal mucosa, with or without lymphadenopathy.
- Seventeen men underwent biopsy and histological examination during investigations for malignancy that the review deemed unnecessary.
- Reported characteristics included living with HIV, oral and condomless anal sex, multiple or non-regular partners, recreational drug use or chemsex, and co-infections.
Why it matters
Oral syphilis can present with diverse lesions and may be considered in patients with oral findings alongside relevant sexual and infection histories. The reported malignancy investigations illustrate that diagnostic pathways may involve invasive procedures when the presentation is not recognised. These case-based findings can inform clinical awareness and future guidance, while not establishing how common these features are among all MSM with oral syphilis.
What to keep in mind
The review synthesised 47 cases from 34 manuscripts, so findings may not represent the broader population of MSM with oral syphilis. The evidence was narratively synthesised from published reports.