Purpose of review
The past 15 years have seen a dramatic increase in
syphilis diagnoses in several regions including China, North America, Western Europe and Australia. Worldwide, the disease remains prevalent, contributing to substantial adult morbidity and neonatal mortality.
Testing and
treatment strategies are largely informed by data from the early antibiotic era, but increasing use of molecular diagnostics and new screening strategies could improve the management of
syphilis substantially.
Recent findings
The review explores new
testing strategies for
syphilis, including the importance of screening test selection and advances in point-of-care diagnostics. It then examines molecular studies of
Treponema pallidum, covering
typing; macrolide resistance; association between genotype and phenotype and the use of PCR in
testing and monitoring strategies.
Summary
Clinicians should be aware of
testing strategies employed by their laboratories to ensure optimal sensitivity and specificity. Locally available
T. pallidum PCR assays may improve the diagnosis of early disease and inform antibiotic choice. Robust serologic follow-up is still required, but predictors of potential
treatment failure, including PCR-measured bacterial load, have been identified. Re-
treatment should be considered for patients in the serofast state. The publication of
T. pallidum genomes would allow further and more detailed study of strains and disease pathogenesis.
