Syphilis: recommendations for dermatologists on a resurgent epidemic

Abstract

Despite reaching historical lows in the early 2000s, cases of both primary and secondary syphilis and congenital syphilis have increased dramatically in the U.S. over the last decade. In the U.S., the current syphilis epidemic is disproportionately impacting communities that have been historically underserved in medicine. These include men who have sex with men, especially those infected with HIV; people of color; and reproductiveage women with poor access to prenatal care. With syphilis now being more commonly diagnosed in non-STI than STI clinics in all genders, and since primary and secondary syphilis and congenital syphilis present with characteristic mucocutaneous manifestations, dermatologists are in a position to help reduce the advance of this preventable epidemic, by actively considering this diagnosis and incorporating syphilis screening into their practice. Herein, we delineate strategies by which dermatologists can contribute to this critical effort in their roles as clinicians, public health advocates, and researchers. In particular, we discuss the rapidly changing demographics of syphilis, nuances in serologic testing and treatment, strategies to increase public healthcare access and equity in these underserved populations, and research gaps in this field.

An Atypical Cutaneous and Histopathological Manifestation of Secondary Syphilis in an HIV-Positive Male: A Case Report

“…The diagnosis of syphilis according to its stage should be approached with caution because of the diverse range of symptoms that syphilis, also known as the "The Great Imitator," can present with [4]. This is important for all physicians to be aware of, including dermatologists, because syphilis diagnoses are becoming more common in non-STD focused clinical settings [5]. In addition to variable symptoms, syphilis cannot always be diagnosed by biopsy.…”