Syphilis Tongue: Here's What to Know

Medically reviewed on July 19, 2023 by Jordan Stachel, M.S., RDN, CPT. To give you technically accurate, evidence-based information, content published on the Everlywell blog is reviewed by credentialed professionals with expertise in medical and bioscience fields.

Table of contents

• What Is Oral Syphilis?
• How Is Oral Syphilis Diagnosed and Treated?
• How Can You Prevent Oral Syphilis?
• Prioritize Your Sexual Health
• Related Content

In 2021, more than 2.5 million cases of sexually transmitted diseases (STDs) were reported in the United States. Instances of syphilis, specifically, have risen significantly in recent years. [1]

Syphilis is characterized by sores, skin rashes, and even organ failure in later stages. And in some cases, syphilis symptoms can develop orally, affecting the lips, tongue, and skin around the mouth.2 That said, the tongue is the most commonly affected site in instances of oral syphilis, with syphilis tongue being present in 33.9 percent of cases. [3]

So, what exactly does syphilis tongue look like, and what are the signs of oral syphilis? It is explored further below.

What Is Oral Syphilis?

Syphilis is a sexually transmitted disease that’s contracted through vaginal, anal, or oral intercourse. [4] Following relations with an infected person, a bacteria known as Treponema pallidum (T. Pallidum) can cause an infection, which develops in stages, including [5]:

• Primary – Primary syphilis refers to the first two to 12 weeks following exposure. A hard, small sore or an oral lesion called a ‘syphilitic chancre’ will develop on the body. Barring a genital chancre developing, 40 to 75 percent will occur in the mouth. And approximately four to 12 percent of people with primary syphilis have oral chancres. [3] Typically, chancres are painless and will disappear just as quickly as they formed. However, the infection is still present, and those with primary syphilis require medical treatment. If they fail to receive treatment, the syphilis will progress to the secondary stage. [5]
• Secondary – A bumpy rash will replace the syphilis sore about one to six months following its disappearance. The rash can be widespread, covering the hands, feet, and mouth. While the rash is not itchy, those in the secondary stage of syphilis can experience a fever, fatigue, wart-like sores, muscle aches, headaches, hair loss, swollen lymph nodes, and weight loss. During this stage, syphilis can be passed to a sexual partner. Like the sore, the disappearance of the rash does not mean the infection is gone. Rather, the rash will continue to resurface until treated. [5]
• Latent – Those who fail to get treatment within the first two stages of development will then experience latent syphilis. During this stage, symptoms will rarely manifest outwardly; however, the infection can begin to damage the heart, bones, nerves, and organs. Fortunately, it’s unlikely that those with latent syphilis will pass on the infection to sexual partners. [5]
• Tertiary – While some types of syphilis infection may remain latent, other infections may enter the tertiary stage. This stage can significantly impact the person’s health and may lead to brain damage, heart disease, movement disorders, nerve damage, seizures, and vision problems. [5]

Symptoms of oral syphilis can occur in the primary, secondary, and tertiary stages of syphilis. It’s spread through oral sex when T. Pallidum bacteria infect a cut in the lips or mouth. Fortunately, syphilis cannot spread through contact with objects, such as eating utensils. [5]

Oral syphilis manifests in the form of an oral lesion and/or syphilitic chancre, which can be found on the [3]:

• Lip
• Tongue
• Buccal mucosa
• Palate
• Gingiva
• Tonsillar pillar

Most people with primary oral syphilis will also experience lymphadenopathy, or the swelling of the lymph nodes, which may feel tender to the touch. White mucous patches can develop on moist tissue, such as the tongue, during the secondary stage. This can mimic a condition called ‘leukoplakias’, in which white tissue develops in the mouth as a result of chewing tobacco, frequent smoking, or drinking excessive amounts of alcohol. [3]

The symptoms of oral syphilis can often mimic other diseases and inflammatory responses, making it more difficult to diagnose the infection properly. [3]

However, it's important to note that syphilis can also affect other parts of the body, including the eyes. In some cases, syphilis can manifest as ocular syphilis, which involves the infection spreading to the eyes and causing symptoms such as blurred vision, redness, and eye pain.

During the tertiary stage, oral syphilis can manifest as inflammation sites called ‘gumma’, which are most commonly found on the tongue or palate. Sometimes, gumma on the tongue can cause luetic glossitis, leading to a red, swollen tongue. The papillae, raised protrusions that contain the taste buds, may also disappear, giving the tongue a smooth appearance.

See related: Can You Get Syphilis Without Having Sex?

How Is Oral Syphilis Diagnosed and Treated?

If you’re experiencing sores or rashes following sexual contact, speak with your healthcare provider. They’ll meet with you to discuss your sexual history and order a blood test to identify possible infections. [5]

In the case of oral syphilis, a healthcare provider may also extract a fluid sample from the syphilis sore or conduct a tissue biopsy to rule out other causes of symptoms.

In all stages, oral syphilis can be treated with an antibiotic like penicillin. After completing your treatment plan, your healthcare provider will order another blood test to ensure the syphilis infection is no longer in your body. [5]

While syphilis is curable, damage done to organs in the later stages cannot be undone.

How Can You Prevent Oral Syphilis?

Abstaining from sex is the only way to fully prevent oral syphilis; however, you can significantly reduce your chances of contracting the infection by practicing safe sex, such as [5]:

• Using protection, like a condom or dental dam
• Discussing you and your partners’ sexual histories prior to intercourse
• Asking if your partner has been tested (and treated) for STDs

Prioritize Your Sexual Health

Oral manifestations of syphilis can often occur after partaking in oral sex with a partner who is infected with the syphilis bacteria, Treponema pallidum. Accordingly, those with oral syphilis often experience sores and rashes in or around the mouth, including on the tongue.

To stay on top of your sexual health, regular testing for STDs is essential. If you're pregnant, it's crucial to be aware of the potential risks associated with syphilis. Syphilis in pregnancy can lead to severe complications, including transmission of the infection to the fetus.

Everlywell offers an at-home Syphilis Test that will measure a sample of blood for Treponema pallidum antibodies to identify whether you’ve been infected. If your test results are abnormal, Everlywell can help you connect with a healthcare provider to discuss treatment options and follow-up testing.

Online STD treatment services are also offered to address concerns about your sexual health. You can meet with a licensed clinician online for recommendations and treatment advice.

Take control of your health with Everlywell.

Related Content

Syphilis in Pregnancy: What You Need to Know

Can You Get Syphilis Without Having Sex?

Ocular Syphilis: A Quick Guide

References

1. CDC. Preliminary 2021 STD Surveillance Data. www.cdc.gov. Published September 1, 2022. URL. Accessed June 12, 2023.
2. de Andrade R, de Freitas E, Rocha B, Gusmao E, Filho M, Junior H. Oral findings in secondary syphilis. Medicina Oral Patología Oral y Cirugia Bucal. Published online 2018. URL. Accessed June 12, 2023.
3. Smith MH, Vargo RJ, Bilodeau EA, et al. Oral Manifestations of Syphilis: a Review of the Clinical and Histopathologic Characteristics of a Reemerging Entity with Report of 19 New Cases. Head and Neck Pathology. 2021;15(3):787-795. URL. Accessed June 12, 2023.
4. Centers for Disease Control and Prevention. STD Facts - Syphilis. CDC. Published 2019. URL. Accessed June 12, 2023.
5. Cleveland Clinic. Syphilis: Symptoms, Treatments. Cleveland Clinic. Published August 13, 2020. URL. Accessed June 12, 2023.