Syphilis Control — A Continuing Challenge

Abstract
Syphilis. The name of this widespread and ancient disease is familiar to health care providers worldwide. This name recognition, however, belies the complexity of the disease, as well as the diagnostic and therapeutic challenges that continue to affect global efforts to control syphilis. Early (primary or secondary) syphilis is typically marked by ulcerative lesions that occur initially at the site of inoculation, followed several months later by widespread cutaneous, mucosal, and even systemic manifestations of the dissemination of the causal agent, Treponema pallidum (see Figure 1 ). Even without treatment, both primary and secondary lesions resolve, and the infection enters a “latent” stage. During this stage, there are no clinical manifestations of disease, yet the infection may still be passed to children born to infected mothers; it may also progress, resulting in late (tertiary) manifestations, including late neurosyphilis, cardiovascular disease, and space-occupying inflammatory lesions (gumma). The ill effects of syphilis, however, go far beyond the disease's effect on individual infected persons. Early syphilis is associated with the infection of sexual partners and an increased risk of acquisition or transmission of human immunodeficiency virus (HIV). The transmission of syphilis to infants of untreated mothers may occur at any stage of infection.

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