Syphilis

Early syphilis is re-emerging in Europe and the USA. The manifestations of syphilis are protean and may mimic many clinical conditions; a high index of suspicion is important. HIV co-infection is common and the two may interact adversely with each other. Diagnosis is by identification of treponemes and treponemal serological tests. Point-of-care treponemal serological tests and multiplex polymerase chain reaction tests for anogenital ulcers can facilitate rapid diagnosis. Penicillin is the treatment of choice. Macrolides should be used with caution in view of the emergence of macrolide-resistant Treponema pallidum. Partner notification and screening of high-risk groups are essential in controlling syphilis. Genomic sequencing of different treponemes enables differentiation from each other, and the potential for novel applications.