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Syphilis

Nature Reviews Disease Primers volume 3, Article number: 17073 (2017) Cite this article

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Abstract

Treponema pallidum subspecies pallidum (T. pallidum) causes syphilis via sexual exposure or via vertical transmission during pregnancy. T. pallidum is renowned for its invasiveness and immune-evasiveness; its clinical manifestations result from local inflammatory responses to replicating spirochaetes and often imitate those of other diseases. The spirochaete has a long latent period during which individuals have no signs or symptoms but can remain infectious. Despite the availability of simple diagnostic tests and the effectiveness of treatment with a single dose of long-acting penicillin, syphilis is re-emerging as a global public health problem, particularly among men who have sex with men (MSM) in high-income and middle-income countries. Syphilis also causes several hundred thousand stillbirths and neonatal deaths every year in developing nations. Although several low-income countries have achieved WHO targets for the elimination of congenital syphilis, an alarming increase in the prevalence of syphilis in HIV-infected MSM serves as a strong reminder of the tenacity of T. pallidum as a pathogen. Strong advocacy and community involvement are needed to ensure that syphilis is given a high priority on the global health agenda. More investment is needed in research on the interaction between HIV and syphilis in MSM as well as into improved diagnostics, a better test of cure, intensified public health measures and, ultimately, a vaccine.

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Figure 1: Treponema pallidum.
Figure 2: Incidence of syphilis worldwide.
Figure 3: Molecular architecture of the cell envelope of Treponema pallidum.
Figure 4: Treponema pallidum invasion.
Figure 5: Clinical presentation of primary, secondary and congenital syphilis.
Figure 6: Serological response to primary and secondary syphilis.
Figure 7: Screening algorithms for syphilis.

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Acknowledgements

The findings and conclusions in this report are those of the authors and do not necessarily represent the views of the US Centers for Disease Control and Prevention.

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Authors and Affiliations

  1. London School of Hygiene & Tropical Medicine, Keppel Street, London, WC1E 7HT, UK

    Rosanna W. Peeling & David Mabey

  2. Division of STD Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD and TB Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, USA

    Mary L. Kamb

  3. National Center for STD Control, Chinese Academy of Medical Sciences and Peking Union Medical College Institute of Dermatology, Nanjing, China

    Xiang-Sheng Chen

  4. Department of Medicine, UConn Health, Farmington, Connecticut, USA

    Justin D. Radolf

  5. Department of Surveillance, Prevention and Control of STI, HIV/AIDS and Viral Hepatitis, Ministry of Health, Brasília, Brazil

    Adele S. Benzaken

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  1. Rosanna W. Peeling
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  2. David Mabey
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  3. Mary L. Kamb
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  4. Xiang-Sheng Chen
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  6. Adele S. Benzaken
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Contributions

Introduction (R.W.P. and D.M.); Epidemiology (D.M. and X.-S.C.); Mechanisms/pathophysiology (J.D.R.); Diagnosis, screening and prevention (R.W.P., M.L.K., X.-S.C. and A.S.B.); Management (D.M.); Quality of life (M.K. and A.S.B.); Outlook (all authors); overview of the Primer (R.W.P.).

Corresponding author

Correspondence to Rosanna W. Peeling.

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Competing interests

J.D.R. receives royalties for licensing of syphilis diagnostics reagents. The other authors declare no competing interests.

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Peeling, R., Mabey, D., Kamb, M. et al. Syphilis. Nat Rev Dis Primers 3, 17073 (2017). https://doi.org/10.1038/nrdp.2017.73

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