ABSTRACT
Syphilis is a complex, systemic disease caused by the spirochete Treponema pallidum. Syphilis is most commonly transmitted sexually or congenitally and can involve nearly every organ system. Its clinical progression involves several well-characterized stages: an incubation period, a primary stage, a secondary stage, a latent stage, and a late or tertiary stage. Syphilis during pregnancy is a leading cause of perinatal mortality in sub-Saharan Africa and can cause spontaneous abortion, stillbirth, prematurity, low birth weight, or congenital syphilis. Penicillin is highly effective against syphilis and remains the treatment of choice. This article reviews the epidemiology, clinical features, diagnostic approach, treatment, and prevention of syphilis.
Subject(s)
Syphilis , Anti-Bacterial Agents/therapeutic use , Homosexuality, Male , Humans , Incidence , Male , Risk Factors , Syphilis/diagnosis , Syphilis/epidemiology , Syphilis/pathology , Syphilis/prevention & controlABSTRACT
Diagnosis and treatment of syphilis are challenging because of its variable clinical presentation and course and the lack of definitive tests of cure after treatment. This review of the most recent literature on the epidemiology, clinical manifestations, current diagnosis, and treatment of syphilis is focused toward clinicians who treat patients with this disease. Syphilis coinfection with human immunodeficiency virus is emphasized because it is increasingly common in the United States and affects the initial presentation, disease course, diagnosis, and treatment of syphilis. Of particular consequence is the effect of human immunodeficiency virus on the clinical diagnosis, prevalence, and course of neurosyphilis, one of the most serious consequences of syphilis infection.
Subject(s)
HIV Infections/epidemiology , Syphilis/epidemiology , Algorithms , Anti-Bacterial Agents/therapeutic use , Comorbidity , Diagnosis, Differential , HIV Infections/diagnosis , HIV Infections/drug therapy , Humans , Male , Neurosyphilis/diagnosis , Neurosyphilis/epidemiology , Penicillin G Benzathine/therapeutic use , Public Health , Recurrence , Syphilis/complications , Syphilis/diagnosis , Syphilis/drug therapy , Syphilis Serodiagnosis , Syphilis, Cutaneous/diagnosis , Syphilis, Cutaneous/epidemiology , Treatment Failure , United StatesABSTRACT
We describe a real-time PCR assay for the discrimination of azithromycin-resistant and -susceptible strains of Treponema pallidum. This assay is rapid and allows for as many as 30 clinical specimens to be analyzed simultaneously without the need for DNA sequencing.
Subject(s)
Anti-Bacterial Agents/pharmacology , Azithromycin/pharmacology , Drug Resistance, Bacterial/genetics , Treponema pallidum/drug effects , Treponema pallidum/genetics , DNA Primers , DNA, Bacterial/genetics , Mutation/genetics , RNA, Bacterial/genetics , RNA, Ribosomal, 23S/genetics , Reverse Transcriptase Polymerase Chain ReactionABSTRACT
BACKGROUND: The incidence of syphilis has been increasing in the United States since reaching a nadir in 2000. Several clinical trials have demonstrated that treatment with oral azithromycin may be useful for syphilis control. After reports of azithromycin treatment failures in San Francisco, we investigated the clinical and epidemiologic characteristics of patients with syphilis due to azithromycin-resistant Treponema pallidum infection. METHODS: We reviewed city-wide case reports and conducted molecular screening for patients seen at the San Francisco metropolitan STD clinic (San Francisco City Clinic) to identify patients who did not respond to azithromycin treatment for syphilis or who were infected with azithromycin-resistant T. pallidum. We conducted an epidemiologic investigation and retrospective case-control study to identify risk factors for acquiring syphilis due to azithromycin-resistant T. pallidum. RESULTS: From January 2000 through December 2004, molecular screening of 124 samples identified 46 azithromycin-resistant T. pallidum isolates and 72 wild-type T. pallidum isolates. Six instances of treatment failure were identified through record review. In total, we identified 52 case patients (one of whom had 2 episodes) and 72 control patients. All case patients were male and either gay or bisexual, and 31% (16 of 52) were infected with human immunodeficiency virus. Investigation of patient-partner links and a retrospective case-control study did not reveal a sexual network or demographic differences between cases and controls. However, 7 case patients had recently used azithromycin, compared with 1 control patient. Surveillance data demonstrated that azithromycin-resistant T. pallidum prevalence increased from 0% in 2000 to 56% in 2004 among syphilis cases observed at the San Francisco City Clinic. CONCLUSIONS: Azithromycin-resistant T. pallidum is widespread in San Francisco. We recommend against using azithromycin for the management of syphilis in communities where macrolide-resistant T. pallidum is present and recommend active surveillance for resistance in sites where azithromycin is used.
