Syphilis in Dermatology: Recognition and Management

Area of Science:

• Infectious Diseases
• Dermatology
• Public Health

Background:

• The incidence of syphilis has been increasing in the USA since 2000.
• The coronavirus disease 2019 (COVID-19) pandemic has negatively impacted public health efforts to control sexually transmitted diseases, including syphilis.
• Dermatologists are well-positioned to recognize syphilis due to its predominant mucocutaneous manifestations.

Purpose of the Study:

• To provide a comprehensive guide on the diagnosis and management of syphilis.
• To discuss the current epidemiology, clinical presentations, diagnostic tools, and treatment strategies for syphilis.
• To emphasize the importance of public health reporting and partner management for syphilis control.

Main Methods:

• Review of clinical manifestations, including primary, secondary, and late syphilis.
• Discussion of diagnostic tools: histopathologic staining, darkfield microscopy, direct fluorescent antibody, polymerase chain reaction assays, and serologic testing (non-treponemal and treponemal).
• Presentation of diagnostic and management algorithms based on Centers for Disease Control and Prevention (CDC) guidelines.

Main Results:

• Syphilis presents with diverse mucocutaneous lesions, systemic symptoms, and potentially late-stage complications.
• Serologic testing is the preferred method for screening and diagnosis, with established algorithms.
• Penicillin remains the primary treatment, with alternative therapies available for specific situations.

Conclusions:

• Early recognition, accurate diagnosis, and appropriate management are crucial for controlling syphilis.
• Syphilis is a reportable disease, requiring adherence to state-specific reporting requirements.
• Effective syphilis control involves screening, partner management, and close clinical follow-up.