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AT-A-GLANCE

AT-A-GLANCE

  • A disease caused by the spirochete Treponema pallidum subspecies pallidum that is almost exclusively sexually transmitted.

  • In the United States, syphilis disproportionately affects men who have sex with men and African American heterosexual communities.

  • The most common and recognizable manifestations are usually cutaneous.

  • Syphilis passes through 4 distinct clinical phases:

    • Primary stage, characterized by a chancre.

    • Secondary stage, characterized typically by skin eruption(s) with or without lymphadenopathy and organ disease.

    • A latent period of varied duration, characterized by the absence of signs or symptoms of disease, with only reactive serologic tests as evidence of infection.

    • Tertiary stage, with cutaneous, neurologic, or cardiovascular manifestations.

  • Neurosyphilis and ophthalmic syphilis can occur at any stage.

  • The recommended treatment for most types of syphilis is benzathine penicillin G, with dose and administration schedule determined by disease stage.

  • Any patient diagnosed with syphilis should be tested for other sexually transmitted infections, including HIV.

DEFINITIONS

Syphilis is a sexually transmitted infection caused by Treponema pallidum subspecies pallidum. Many of its manifestations are cutaneous, making it of interest and importance to dermatologists, especially as morbidity from syphilis rises in the developed world and continues in the developing world.

HISTORICAL PERSPECTIVE

Whether syphilis arose in the New World, the Old World, or both remains a controversial subject.1-3 Pandemics of syphilis began in the Old World in Naples, Italy, 1 year after Columbus returned from the New World.2,4,5 Syphilis earned the monicker “great pox,”5 to distinguish it from another virulent disease with cutaneous manifestations, smallpox. The disease takes its name from a poem, called Syphilis, Sive Morbus Gallicus (Syphilis, or the French Disease), written in 1530 by Giralomo Fracastoro, a physician and poet of Verona. Part of the poem recounts the story of a shepherd, named Syphilus, who, as punishment for angering Apollo, was afflicted with the disease known as syphilis.4 Other names besides Morbus Gallicus and the Great Pox by which the disease has been known include lues, the Great Mimic, the Great Masquerader, the Great Imitator, and the Neapolitan disease.4 The cause of syphilis, the bacterium T. pallidum, was discovered by Schaudinn and Hoffman in 1905.6 Darkfield microscopy was pioneered in 1906 by Landsteiner, and serologic testing for syphilis was pioneered in 1910 by Wasserman.5

Because of the skin manifestations, syphilis historically has been of major interest to dermatologists, who were leaders in syphilis research and treatment in Europe and the United States, especially in the prepenicillin era.7-12 One of the leading American dermatology journals, currently called Archives of Dermatology, was before 1955 called Archives of Dermatology and Syphilology. An editorial explaining the jettisoning of “Syphilology” from the journal’s title stated:

The diagnosis and treatment of patients with syphilis is no longer an important part of dermatologic practice. The papers ...

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