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
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
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.
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.