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Home Books Fitzpatrick's Dermatology in General Medicine, 8e

Chapter 200. Syphilis

Kenneth A. Katz

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Syphilis at a Glance
  • A disease caused by the spirochete Treponema pallidum subspecies pallidum that is usually sexually transmitted.
  • In the United States, syphilis disproportionately affects men who have sex with men and blacks.
  • The most common and recognizable manifestations are usually cutaneous.
  • Syphilis passes through four distinct clinical phases:

    1. Primary stage, characterized by a chancre.

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

    3. 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.

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

  • The recommended treatment for most types of syphilis is benzathine penicillin G, with dose and administration schedule determined by disease stage.
  • Persons with human immunodeficiency virus infection are at higher risk of treatment failure and to neurosyphilis.

Syphilis is an infection caused by Treponema pallidum subspecies pallidum. It can cause serious disease in persons who acquire it after birth and especially devastating disease in persons who acquire it in utero. 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.

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 was much more virulent then, earning it the monicker “great pox,”4 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.5 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.5 The cause of syphilis, the bacterium T. pallidum, was discovered by Schaudinn and Hoffman in 1905.6 Darkfield microscopy and serologic testing for syphilis were pioneered, respectively, in 1906 by Landsteiner and in 1910 by Wasserman.4

Syphilis historically has been of major interest to dermatologists, who were leaders in syphilis research and treatment in Europe and the United States.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 as follows:

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

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