Diagnosis of syphilis: Clinical and laboratory problems

JDDG | 12 ̇2006 (Band 4) © The Authors • Journal compilation © Blackwell Verlag, Berlin • JDDG • 1610-0379/2006/0412-1058 Introduction Due to HIV prevention campaigns there was a sharp decline in the incidence of classical sexually transmitted diseases in many Western European nations at the end of the 1980s and beginning of the 1990s. Also, the initially high mortality of AIDS contributed to the reduction of syphilis cases. After a dramatic increase of syphilis in the countries of the former Soviet Union since 1994, outbreaks have been registered in Great Britain, Ireland, France, Holland and Norway [1]. Similar trends can be observed in Germany and Switzerland [2–4]. The increase in syphilis observed for years continued in 2004 [2, 4] with 3,345 newly diagnosed cases being reported in Germany, an incidence rate of 4.1 cases per 100,000 population, a 14 % increase compared to 2003 [2]. Syphilis in Europe is observed mainly in large cities among young adults. Homosexual males in particular are affected, many of whom have known HIV infections [5]. The HIV co-infection rate varies greatly depending on country but ranges up to 50 %. Most recent trends also show a rise in syphilis among heterosexual men [2]. Particularly worrisome is that the rise in syphilis correlates with the renewed increase of sexually acquired HIV infection, which has risen by 20 % between 1995 and 2000 [1]. The return of syphilis presents a diagnostic challenge for young physicians who are often not familiar with the clinical presentation, diagnostic approach or treatment. We must re-familiarize ourselves with the diverse clinical features of syphilis [6] and the complex diagnostic approach to this disease [7, 8]. It is especially crucial to recognize the diverse clinical symptoms of each individual stage and to keep them in mind in considering differential diagnoses. The key to diagnosis is examination of the entire skin surface and its appendages, the anogenital region, the oral mucosa and regional lymph nodes while considering possible general and neurologic symptoms. The peculiarities in simultaneous HIV co-infection must especially be considered. To stop the current spread of syphilis, we must once more become familiar with the complex clinical presentation and diagnostic approach. Rapid diagnosis and treatment are essential to prevent further spread, late complications, transfer to the newborn and may represent a key to reducing new sexually acquired HIV infections.