Tijdschrift voor geneeskunde vol:62 issue:5 pages:339-347
Syphilis is a sexually transmitted disease, with an increasing incidence over the last decade. Especially homosexual men who are co-infected with the human immunodeficiency virus (HIV) suffer from syphilis, both epidemics fuelling each other. The disease, caused by Treponema pallidum, presents as a genital ulcer. After spreading through the body, the disease passes through a series of overlapping stages, and finally infects the central nervous system and aorta.
Diagnosis is based on clinical presentation, serological testing, and microscopic identification of the causative treponeme.
Penicillin remains the mainstay of therapy, being supported by clinical experience from the past rather than by controlled trials. Doxycycline is the second choice, except for neurosyphilis.
Treatment failure occurs, and follow-up is essential.
Management of people with HIV co-infection requires special attention.