Usually, no fever occurs unless there is secondary infection. The ulcerations, usually limited to the marginal gingiva and interdental papillae, have a characteristic punched-out appearance. They are covered by a grayish membrane and bleed with slight pressure or irritation. Similar lesions on the buccal mucosa and tonsils are rare. Swallowing and talking may be painful.
Regional lymphadenopathy is often present.
The punched-out appearance of the interdental papillae, grayish interdental membrane, spontaneous bleeding, odor, and pain are pathognomonic. An overwhelming number of fusospirochetal forms in stained smears from the lesions confirms the diagnosis. When tonsillar or pharyngeal tissues are affected, early differentiation from diphtheria or infection accompanying agranulocytosis is essential. In such cases, the differential diagnosis must include streptococcal or staphylococcal pharyngitis. Treatment consists of gentle, thorough local debridement.