Syphilis

The incidence of syphilis is higher than it has been in over 30 years with over 35,000 new cases reported in 1987. Despite this, the teaching of this disease has largely been ignored in medical schools, resulting in a very low index of suspicion by the medical profession. This article has reviewed the salient clinical features, the laboratory tests used in the diagnosis and tests of cure, and the treatment schedules, both the well-documented and those still to be evaluated. Recent disturbing facts have emerged in patients with HIV infection who also have syphilis. In these individuals the serious "late" manifestations, such as involvement of the central nervous system, may occur with greater than expected frequency and appear earlier in the course of the disease than usual. The humoral response on which the diagnostic tests are based may be altered or absent, and the response to treatment may not be as effective as that obtained in an immunocompetent individual.