Syphilis
Syphilis is an infection that has intrigued scientists, baffled clinicians, and terrified patients for centuries. Although an inexpensive and highly effective treatment has been available for 60 years, syphilis continues to be a public health problem in b
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History . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 447 T. pallidum subspecies pallidum: The Causative Agent . . . 448 The Natural History and Pathogenesis of Syphilis . . . . . . . . 449 Transmission–Attachment . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 450 Primary Syphilis: Local Proliferation, Dissemination, and Immune Clearance . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 451 Secondary Syphilis: Motility, Systemic Inflammation, and Host Immune Response . . . . . . . . . . . . . . . . . . . . . . . . . . . . 452 Effect of Concurrent HIV Infection on Clinical Course of Syphilis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 454 Early CNS Invasion and Neurological Involvement . . . . 455 Latent Syphilis: Immune Evasion, Surface-Exposed Antigens, and Recurrent Secondary Syphilis . . . . . . . . . . . . 455 Tertiary Syphilis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 457 Congenital Syphilis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 458 Diagnosis of Syphilis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 459 Treatment . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 460 Alternative Antibiotic Treatments . . . . . . . . . . . . . . . . . . . . . . . 460 Jarisch-Herxheimer Reaction . . . . . . . . . . . . . . . . . . . . . . . . . . . . 461 Molecular Strain Typing of T. pallidum . . . . . . . . . . . . . . . . . . . . 461 Vaccine Development and Prevention . . . . . . . . . . . . . . . . . . . . . 462 Concluding Statement . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 462
Abstract Syphilis is an infection that has intrigued scientists, baffled clinicians, and terrified patients for centuries. Although an inexpensive and highly effective treatment has been available for 60 years, syphilis continues to be a public health problem in both developed and developing parts of the world. The protean clinical manifestations, long periods of asymptomatic infection, and lifelong persistence of syphilis suggest a highly complex relationship between Treponema pallidum and the host’s immune response. The extreme fragility of the causative bacterium and the inability to cultivate it in vitro have impeded progress in identifying and understanding the important virulence factors. The absence of an inbred animal model of syphilis and the consequent lack of immunological reagents complicate progress further. Despite these difficulties, the post-genomic era has yielded a new understanding of the molecular interactions of
T. pallidum and the host. In this chapter, we present our current understanding of the mechanisms of syphilis pathogenesis in the context of a discussion of the clinical stages of syphilis.
History Few diseases elicit the simultaneous disdain, fear, and fascination as does syphilis. There is much lore surroun
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