Editorial Commentary: A Syphilis Wish List: Better Data, Better Tests

Abstract

William Osler referred to syphilis as “The Great Imitator,” referring to the vast array of potential clinical presentations and morbidity associated with syphilis at the beginning of the 20th century. While the infection’s varied presentations remain a continuing source of confusion for clinicians, the challenges of syphilis management do not stop with diagnosis. The absence of readily available culture or other direct microbiologic tests for syphilis diagnosis, and the resulting dependence upon serological testing to evaluate response to therapy, regularly creates questions for clinicians. For better and for worse, serological testing for syphilis diagnosis and monitoring response to therapy has been a mainstay of syphilis management since soon after 1906 when Wassermann and colleagues developed the first serological tests for syphilis [1]. Since then however, evolution of tests, testing methods, reagents, and test formats has not resolved fundamental questions or limitations of currently available tests. Syphilis is no longer common enough to be easily studied at a single institution in the numbers needed to provide conclusive answers to important management questions but it is common enough that questions regularly arise in management of syphilis patients. In the United States, rates of primary and secondary syphilis have been 15 years [2] and rates are still lower in Western Europe. Nonetheless, questions regarding serological test interpretation continue to vex clinicians at all stages of syphilismanagement—diagnosis,staging, and response to therapy. Furthermore,