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EspañolSyphilis tongue symptoms: What are the early signs of syphilis tongue?
What does syphilis tongue look and feel like?
Syphilis tongue is a symptom of second-stage syphilis, a common sexually transmitted infection (STI). Syphilis infections are easily spread from person to person through skin-to-skin sexual contact, including vaginal sex, anal sex, and oral sex. Syphilis can also spread from a pregnant mother to her unborn baby. The first symptom is a painless but contagious sore (or sores) that appears on the genitals, anus, rectum, lips, or mouth. When a syphilis sore first appears in the mouth, it’s called oral syphilis. This sore can erupt on the tongue, inner lips, or other mucous membranes inside the mouth and heals by itself in a few weeks. Later, the syphilis infection causes skin rash, warts, skin lesions, fever, and sore throat. White patches or sores can appear on the tongue (“syphilis tongue”), inner lips, or other areas of the oral cavity. These, too, clear up on their own in a few weeks. That doesn’t end the infection, though. It spreads throughout the body and could later affect the nervous system and vital organs.
Key takeaways:
Syphilis tongue is a common health condition that can affect anyone regardless of age, sex, race, or ethnicity.
Early signs of syphilis tongue include one or more painless sores on the tongue, inner lips, and mucosal surfaces inside the mouth.
Serious symptoms of syphilis, such as headache, neck stiffness, aversion to light, vision changes, eye pain, hearing loss, vertigo, dizziness, dementia, or paralysis, may require immediate medical attention.
Syphilis tongue is caused by a bacterial infection caused by Treponema pallidum. The primary way people get oral syphilis is through oral sex with a person who has infected sores. You may be at risk for developing syphilis tongue symptoms if you have unprotected sex, multiple sexual partners, or sex with another person infected with syphilis.
Syphilis tongue usually requires a medical diagnosis.
Syphilis tongue requires treatment. Syphilis tongue symptoms typically resolve on their own because they only occur in the secondary stage of the infection. The infection itself remains and must be treated.
Treatment of syphilis tongue involves antibiotics.
Untreated syphilis tongue could result in complications like nervous system disorders, heart problems, lesions on internal organs, permanent blindness, permanent hearing loss, partial paralysis, dementia, and death.
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What are the early signs of syphilis tongue?
The earliest sign of oral syphilis is one or more painless sores on the tongue or other surfaces in the mouth. According to a 2021 study, 92% of people diagnosed with oral syphilis have just one sore. Of those, 37% have a sore on the tongue (“syphilis tongue”). About one in 12 people will have multiple sores in the mouth.
Chancres are symptoms of primary syphilis. The tongue can be involved in secondary syphilis, as well. Called “syphilis tongue,” the early sign of the syphilis infection could be a chancre that forms on the genitals, anus, lips or in the mouth.
Other syphilis tongue symptoms
The first stage of syphilis symptoms typically involves the area of the skin or mouth where the infection first took hold. The infection soon spreads to the rest of the body, so the second stage involves symptoms affecting much of the skin and the body.
In the primary stage of oral syphilis infection, symptoms include:
One or more painless sores on the tongue, lips, palate, or other soft tissues in the mouth
Swollen lymph nodes
In the secondary stage of oral syphilis, symptoms include:
White or pink patches inside the mouth: tongue, lips, palate, and mucosal tissues
Skin rashes
Raised pale lesions in the mouth, underarms, or groin
Fever
Feeling sick (malaise)
Muscle soreness
Sore throat
Fatigue
Syphilis tongue vs. geographic tongue
When the tongue is involved in primary-stage syphilis, it’s usually the appearance of a painless sore or sores on the tongue. “Syphilis tongue” describes what happens to the tongue in secondary stage syphilis. In some cases, the entire tongue can be covered by white or gray patches. These patches are infectious. They go away in two to 12 weeks. Geographic tongue is a harmless condition that causes smooth, red patches on the tongue. Since infections don’t cause these patches, they aren’t infectious. There’s no cure, but they can clear up in a few days or persist for years.
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Stages of syphilis tongue
Syphilis is a body-wide infection that passes through several stages:
Primary oral syphilis: About three weeks after being infected, the first sign of an infection is one or more syphilis sores (chancres) in the mouth. The chancre oozes a liquid filled with syphilis bacteria, so the infection is highly contagious. The chancre heals on its own in three to six weeks.
Secondary syphilis: Two to eight weeks after the chancre heals, syphilis symptoms affect the entire body and are most apparent on the skin. These symptoms include skin rash, warts (condyloma lata), hair loss, and lesions. Oral manifestations of syphilis in this stage could include multiple sores or patches in the mucosa of the oral cavity or the tongue (“syphilis tongue”). These symptoms go away on their own in two to 12 weeks without treatment. During this period, the skin lesions are highly contagious.
Latent syphilis: Starting around one year after the onset of symptoms, the infection enters a latent stage where it causes no or only mild symptoms and is not contagious. The latent stage can last years. Some people with syphilis will never progress to the last stage.
Tertiary syphilis: In its final, late stage, the syphilis infection spreads to other organs and systems in the body. It can cause tumor-like growths called gummas on internal organs, but it can also spread to the nervous system or heart and cause serious complications.
Syphilis can spread to other areas of the body and cause distinctive syphilitic diseases, including:
Neurosyphilis occurs when syphilis bacteria invade and infect the nervous system. This can happen at any stage of a syphilis infection. Symptoms include headache, nausea, vertigo, paralysis, vision changes, mood changes, cognitive impairment, delirium, dementia, and psychosis.
Ocular syphilis happens when the bacteria infect the eyes. This can happen at any stage of syphilis and can infect any tissues in the eyes. Symptoms include eye chancres, redness, swelling, vision changes, and permanent blindness.
Otosyphilis is the result of syphilis invading the inner ear. It, too, can happen at any stage of the infection. Symptoms include ringing in the ear (tinnitus), hearing loss, vertigo, and possibly permanent hearing loss.
When to see a doctor for syphilis tongue symptoms
Always see a healthcare provider or get tested if you have symptoms of syphilis or any other sexually transmitted disease (STD). Treatment is necessary.
The only way to definitively diagnose a syphilis infection is a nonspecific blood test and a specific blood test for Treponema antibodies. A positive syphilis may result in other STD tests, as well. The clinician can use a microscopic biopsy of a lesion sample to identify the bacteria if there are lesions.
A healthcare professional will also take a medical history and do a thorough physical when diagnosing syphilis. They will look for any signs that the infection may have invaded the nervous system, eyes, or ears. If there’s evidence of neurosyphilis, the clinician will perform a complete cerebrospinal examination and do a spinal tap to test for the bacteria.
Complications of syphilis tongue
Syphilis is a serious infection that can cause complications such as irreversible heart damage or neurological damage. If the infection spreads to the nervous system, eyes, or ears, complications include cognitive decline, stroke, facial palsies, partial paralysis, permanent blindness, permanent hearing loss, dementia, and death. If the infection invades the cardiovascular system, complications could include heart and organ problems.
How to treat syphilis tongue symptoms
Syphilis must be treated with antibiotics to eradicate the infection.
The standard treatment is a single intramuscular dose of penicillin. Alternative antibiotics are used for people who cannot be given penicillin, including oral doxycycline, tetracycline, or ceftriaxone injections. Neurosyphilis and tertiary syphilis are treated with more frequent penicillin injections over two to three weeks. Follow-up evaluation and retesting occurs six, 12, and 24 months after treatment ends.
Signs syphilis tongue is getting better
Syphilis typically doesn’t have symptoms. If treatment occurs while symptoms are active, the symptoms should fade in a few days. But they will fade anyway without treatment. The only way to know syphilis is getting better is to get periodic blood tests at six months, 12 months, and 24 months.
Most importantly, get tested and treated
Whether you have symptoms or not, get tested if you have reason to believe you’re infected. People who have risk factors for contracting an STI, including multiple sex partners, unprotected sex, or sex with a partner infected with a syphilis infection, should get tested. It’s important to get treated immediately to halt the spread of the infection.
What’s next? Additional resources for people with syphilis tongue symptoms
Test and diagnostics
Syphilis, StatPearls
Syphilis CDC basic fact sheet, Centers for Disease Control and Prevention (CDC)
Treatments
Syphilis, StatPearls
Syphilis treatments and medications, SingleCare