Syphilis: an update

The incidence of infectious syphilis in the UK has greatly increased since 1995, mainly in cities and commonly among gay men. Syphilis is a systemic disease from the outset. It usually presents early with a painless penile ulcer, or later with a maculopapular rash, lymphadenopathy and condylomata lata. Diagnosis is confirmed serologically, at first by specific treponemal screening and confirmatory tests (eg enzyme immunoassay and Treponema pallidum particle agglutination test), subsequently by non-specific serology (eg rapid plasmin reagin test) to gauge disease activity. Clinical suspicion of neurosyphilis should be confirmed by analysis of a clear specimen of cerebrospinal fluid. The cornerstones of management are rapid investigation and treatment, tracing and treating sexual contacts, and education about safer sex.