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2016 ; 3
(9
): 363-370
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Syphilis: Re-emergence of an old foe
#MMPMID28357375
Stamm LV
Microb Cell
2016[Jun]; 3
(9
): 363-370
PMID28357375
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Syphilis is caused by infection with Treponema pallidum subsp. pallidum, a
not-yet-cultivable spiral-shaped bacterium that is usually transmitted by sexual
contact with an infected partner or by an infected pregnant woman to her fetus.
There is no vaccine to prevent syphilis. Diagnosis and treatment of infected
individuals and their contacts is key to syphilis control programs that also
include sex education and promotion of condom use to prevent infection. Untreated
syphilis can progress through four stages: primary (chancre, regional
lymphadenopathy), secondary (disseminated skin eruptions, generalized
lymphadenopathy), latent (decreased re-occurrence of secondary stage
manifestations, absence of symptoms), and tertiary (gummas, cardiovascular
syphilis and late neurological symptoms). The primary and secondary stages are
the most infectious. WHO estimates that each year 11 million new cases of
syphilis occur globally among adults aged 15-49 years. Syphilis has re-emerged in
several regions including North America, Western Europe, China and Australia.
Host-associated factors that drive the re-emergence and spread of syphilis
include high-risk sexual activity, migration and travel, and economic and social
changes that limit access to health care. Early, uncomplicated syphilis is
curable with a single intramuscular injection of benzathine penicillin G (BPG),
the first line drug for all stages of syphilis. Emergence of macrolide-resistant
T. pallidum has essentially precluded the empirical use of azithromycin as a
second-line drug for treatment of syphilis. Virulence attributes of T. pallidum
are poorly understood. Genomic and proteomic studies have provided some new
information concerning how this spirochete may evade host defense mechanisms to
persist for long periods in the host.
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