Jyoti Kinghorn 
Syphilis is often called “the great imitator” because its symptoms can mimic those from a variety of other conditions, such as the flu. One of the manifestations of syphilis is syphilitic tonsillitis, also called pharyngeal syphilis, which is the infection of the tonsils by the bacterium that causes syphilis, Treponema pallidum. A rare condition, syphilitic tonsillitis may be seen more frequently in the coming years as syphilis continues to spread across the U.S.
The syphilis epidemic
Syphilis had been nearly eradicated from the U.S. after the widespread use of penicillin which started after the Second World War. However, the disease re-emerged in the 1990s and has been spreading ever since. The CDC reports that between 2018-2022 the reported cases of syphilis increased from 115,000 to 207,000. Currently, the reported cases have reached the highest numbers since the 1950s. The real number of people suffering from syphilis infection is likely greater as not everyone who gets infected seeks treatment.
How tonsils can get infected by syphilis
Tonsils are soft oval pads present at the back of the throat. They are a part of the body’s immune system. Their function is to trap pathogens such as bacteria and viruses that enter through the mouth. Tonsils are rich in white blood cells and are equipped to provide a line of defense against common infections. However, sometimes the tonsillar tissue is unable to successfully neutralize the infection and may get infected and inflamed itself. This condition is called tonsillitis. When the bacteria that cause syphilis are ingested by the mouth (as may happen during oral sex with an infected person) they can get trapped in the tonsils and cause syphilitic tonsillitis.
Symptoms of tonsilitis. General symptoms of tonsillitis include sore throat, swelling and redness of the tonsils, painful swallowing, and enlarged lymph nodes of the neck.
Symptoms of syphilitic tonsillitis. In syphilitic tonsillitis, patients may feel the usual symptoms of tonsillitis such as sore throat and difficult or painful swallowing. The tonsillar infection may be the site of a primary chancre formation or the inflammation may be a part of secondary syphilis. When it is related to secondary syphilis, the patient will also observe other symptoms such as rashes on other parts of the body. Sometimes, syphilis can cause the formation of gummatous lesions (soft tumor-like growth) on the tonsils.S
Syphilitic tonsillitis diagnosis
Syphilitic tonsillitis is exceedingly rare and the symptoms can mimic other infections. Therefore, physicians may check for several infections before they check for syphilis. It is necessary to be honest with your physician about any genital or other symptoms you may be having in addition to the sore throat.
When syphilis is suspected, the following diagnostic tests can detect the infection:
- Serology tests. These tests search the patient’s blood for the presence of antibodies made by the body in response to the infection by Treponema pallidum.
- PCR tests. These tests search for the DNA of Treponema pallidum in the patient’s blood.
Treatment options
Syphilis is a bacterial infection curable by antibiotics. Commonly, intramuscular injections of benzathine penicillin are prescribed to cure syphilis. The number of doses that may be given depends on the stage of the infection and patient characteristics such as age, pregnancy status, etc. Other antibiotics such as doxycycline and azithromycin can also be prescribed instead of benzathine penicillin. In all cases, a repeat blood test will be conducted to check if the treatment was successful.
All sexual partners of the patient should be tested and treated.
Prevention of syphilis
Abstinence, monogamy, and practicing safe sex (using condoms and dental dams correctly) are some of the ways individuals can protect themselves from sexually transmitted infections (STIs) such as syphilis. Individuals most at risk include gay, bisexual, and other men who have sex with men and individuals who have oral, anal, or vaginal sex with partners of unknown STI status.
If treated early, syphilis may not have any long-term detrimental effects on one’s health. However, untreated syphilis can cause multi-organ failure, disfiguration, and death. Syphilis can also pass down from an infected mother to her developing fetus causing stillbirth, premature birth, low birth weight, or congenital syphilis infection in the newborn.
Getting tested is the first step towards getting timely treatment.
To find a testing location near you, visit https://gettested.cdc.gov/.
The information provided in our blog posts is for informational purposes only and is not intended as a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition. Never disregard professional medical advice or delay in seeking it because of something you have read on this blog.
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