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  • • Sexually transmitted disease causing a wide range of systemic manifestations.
  • • Clinical disease occurs in well-characterized stages: primary (chancre), secondary (rash, swollen glands, systemic symptoms) and tertiary (dementia, neuromotor, gummatous, cardiovascular symptoms).
  • • Latent periods of variable duration occur between clinical manifestations of disease.
  • • Clinical disease is confirmed and latent disease diagnosed by two-stage serologic tests.

Syphilis is a complex disease caused by the spirochete Treponema pallidum. It occupies an interesting place in the history of disease, appearing explosively as a virulent epidemic in Europe during the age of exploration, a time of intense scientific inquiry. Although syphilis incidence has waxed and waned over the centuries since, it has never really abated. Penicillin has been and remains the therapy of choice.

Unique among the sexually transmitted diseases, syphilis is characterized by a potential to cause a wide range of systemic manifestations. It can involve nearly every organ system in a variety of ways acutely or more commonly in an insidious and chronic fashion. Latent periods between clinical manifestations may be of variable duration. It has the potential to cause serious congenital disease and appears to enhance the transmission of human immunodeficiency virus (HIV).

Syphilis is typically acquired sexually or congenitally. Rare cases of acquisition through contaminated blood products have been reported. Syphilis can also be spread by skin or mucosal contact with an infectious lesion (eg, through nonsexual direct contact such as skin to skin or kissing). The risk of syphilis following sexual exposure to an individual with infectious syphilis is probably about 30% and is dependent on a variety of factors, including the extent and location of disease in the source patient. Long-standing immunity following infection after treatment does not occur, and repeated infections are possible.

Most syphilis infections are sexually transmitted; therefore, measures that prevent sexual exposure, such as condom use or reduction in the number of sex partners, are effective in reducing the risk of acquiring syphilis. Syphilis is unique among the sexually transmitted diseases because of a well-characterized prolonged incubation period during which infection can be aborted by prophylactic treatment. After sexual exposure infection may be prevented with penicillin G benzathine therapy.

Preventive treatment is highly effective and a mainstay of syphilis control programs. Persons who may have been exposed to syphilis are contacted and offered preventive therapy. Those who receive timely preventive therapy will not undergo seroconversion (see later discussion of serologic testing). Waiting for serologic test results before treatment is not recommended in patients who report syphilis exposure, because the opportunity to prevent infection may be missed. All persons who report exposure should receive preventive treatment, regardless of serologic test results.

Symptoms and Signs

Typical of syphilis is its clinical progression through several well-characterized stages, outlined below.

Primary Syphilis

Incubation after exposure typically lasts from 1 week to ...

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