Syphilis: today

Thanks to the introduction of antibiotic therapy, syphilis has become a curable disease. In December 1954, the famous Hungarian venereologist Erno Kalman, MD, trustingly wrote in his paper published in the Nepegeszsegugy (National Health): 'Based on the results up to now, one may reasonably expect that the practical elimination of new infections with syphilis will become a reality within 1 to 2 years'. This optimistic vision of the future has not come true, as the incidence of syphilis has shown an increasing trend again worldwide, in spite of successful antibiotic therapy being readily available. From the end of the 1990s, Hungarian data reflect the epidemiological trend observed worldwide; a slow decrease was evident until 2004 and stagnation since 2005. With the exception of 2007, more than 500 fresh infections were diagnosed in the country in each year, with an increase of cases diagnosed during pregnancy, as well as among the newborn with congenital syphilis. The current article reviews the detailed microbiology of Treponema pallidum, the clinical manifestations and diagnostic clues relating to different stages of the disease, the diagnostic algorithms, management, therapy, follow-up, and prevention not only of acquired but also of congenital syphilis as well. (C) 2010 Wolters Kluwer Health vertical bar Lippincott Williams & Wilkins