Syphilis: A clinical perspective

Syphilis is a chronic sexually and vertically transmitted infection caused by Treponema pallidum subspecies pallidum, known for its varied clinical manifestations and ability to cross biological barriers. Prevalence is highest in Africa and low- and middle-income countries, with a resurgence in men who have sex with men in high-income countries. Syphilis has several phases: incubation (up to 90 days), primary phase, secondary phase, latent phase and tertiary phase. Primary syphilis begins with a painless chancre and regional lymphadenopathy. The secondary phase includes rash, fever and generalized lymphadenopathy. The latent phase is asymptomatic, and the tertiary phase may cause neurosyphilis and cardiovascular syphilis. Ocular and otic manifestations may also occur. Syphilis is diagnosed with serological tests: nontreponemal (RPR, VDRL) for initial diagnosis and monitoring, and treponemal (FTA-ABS, TPPA) for confirmation. Microscopy and PCR are also useful. In neurosyphilis, CSF is analyzed. Penicillin G is the treatment of choice for all stages of syphilis. Alternatives such as doxycycline are used in allergy sufferers. Prevalence has increased in certain groups, requiring additional strategies.