Laboratory support in the management of syphilis

Recent developments in syphilis serology are set down. The approach today is more rational as it has some basis in immunological understandings. In spite of improvements, syphilis serology continues to have limitations, and differentiating active from inactive cases remains taxing. In primary and secondary syphilis, dark-ground microscopy is still the quickest and surest way to make the diagnosis. In latent syphilis and in late and congenital cases, as well as in instances of other treponemal infections, serological evidence of disease needs to be considered along with each patient's medical, social and sexual history, when and why they may have been given antibiotic treatment, and the results of radiological studies and cerebrospinal fluid examination. For some syphilitics, the decision to treat or not to treat remains a matter of art rather than science.