Emerging trends and persistent challenges in the management of adult syphilis.

Susan Tuddenham,Khalil G Ghanem

doi:10.1186/s12879-015-1028-3

Abstract

There are an estimated 10.6 million incident cases of syphilis worldwide each year. We highlight some persistent challenges and emerging trends in the clinical management of syphilis with a particular focus on therapy, serology, diagnostics, and prevention. Decades after the introduction of penicillin, the optimal management of early syphilis continues to be a controversial topic, particularly in the setting of HIV co-infection. Similarly, the need for routine lumbar puncture in HIV co-infected asymptomatic persons is an unanswered question. Despite advances in both automation and point-of-care diagnostics, we continue to rely on indirect measures of disease activity to manage this infection. As syphilis rates in some populations continue to rise, novel and effective prevention strategies are needed.

Highlights

There are an estimated 10.6 million incident cases of syphilis worldwide each year
The predilection for the development of early symptomatic neurosyphilis among HIV-infected persons [13, 14] and data showing that a single dose of 2.4 MU of benzathine penicillin G (BPG) may be insufficient to clear Treponema pallidum from the CSF of HIV-infected persons with early syphilis [15] have fueled this debate
In the pre-HIV era, three doses of 2.4 MU BPG were recommended as an alternate treatment regimen for neurosyphilis [16]