“…In fact, heat treatment was performed in the past with the knowledge that Treponema are susceptible to increased temperature, and in vitro studies have shown temperatures greater than 408C to be lethal to the organism. 11,13 Regarding metabolic requirements, the Treponemal spirochete is metabolically deficient, lacks an oxidative Krebs cycle, prefers low oxygen environments, and is reliant on the host enzymatic machinery for survival. 14 It is tempting to speculate about the invasive patterns of the syphilis organism during infection and why in rare instances, the spirochetes home to the follicular epithelium, as in our case.…”