Clinical Review

Syphilis

BMJ 2007; 334 doi: https://doi.org/10.1136/bmj.39085.518148.BE (Published 18 January 2007) Cite this as: BMJ 2007;334:143

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Syphilis remains common worldwide, and since the late 1990s infectious early syphilis has re-emerged as an important disease in western Europe, including the United Kingdom.1 The clinical presentation of both early and late syphilis is diverse, and patients may present to a wide range of services and clinicians, including general practitioners. Until recently many doctors will have had relatively little clinical experience of syphilis. This review will emphasise the clinical presentation of syphilis because once syphilis has been suspected diagnosis and curative treatment are usually simple to achieve.

SUMMARY POINTS

  • Syphilis remains a common disease worldwide, and infectious syphilis has recently re-emerged as an important disease in western Europe

  • Syphilis causes considerable morbidity and facilitates HIV transmission

  • The clinical presentation of syphilis is diverse, with patients presenting to a wide range of practitioners and services

  • A high index of suspicion of syphilis and a low threshold for testing for syphilis are essential

  • Diagnosing and treating syphilis are usually straightforward

Sources and selection criteria

This review is based on Pubmed and Medline searches for syphilis (key words: syphilis, English, human) for the past five years (2000 to February 2006). I supplemented this with the literature review done for the development (in 1999) and updating (in 2002) of the UK National Early and Late Syphilis Guidelines (I was a member of the working party that first developed and is currently updating these guidelines).w1,w2, w3

Why is syphilis important?

Syphilis, caused by Treponema pallidum (box 1, fig 1), is a common infection worldwide, with an estimated 10-12 million new infections each year.w4 Early syphilis causes significant morbidity, and a systematic review of HIV transmission studies confirms that it is an important facilitator of HIV transmission.3 Congenital syphilis remains a major cause of stillbirth, childhood morbidity, and mortality worldwide.4 w4 The broad range of manifestations of late syphilis …

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