![]() pallidum is identified by its characteristic corkscrew appearance. Once a serous exudate appears, it is collected on a glass slide and examined under a microscope equipped with a dark-field condenser. In preparation for dark-field microscopy, the lesion is cleansed and then abraded gently with a gauze pad. 2 However, its accuracy is limited by the experience of the operator performing the test, the number of live treponemes in the lesion, and the presence of non-pathologic treponemes in oral or anal lesions. Family physicians should understand its presentations, stage-specific diagnostic testing, and appropriate antibiotic treatments, because missed or inappropriately treated syphilis can result in devastating cardiovascular and neurologic disease, as well as congenital syphilis.ĭark-field microscopy is the most specific technique for diagnosing syphilis when an active chancre or condyloma latum is present. Previously known as the “great imitator,” this disease can have numerous and complex manifestations. Syphilis is a sexually transmitted disease (STD) caused by the spirochete Treponema pallidum. Serial cerebrospinal fluid examinations are necessary to ensure adequate treatment of neurosyphilis. These titers should decline fourfold within six months after treatment of primary or secondary syphilis and within 12 to 24 months after treatment of latent or late syphilis. Once the diagnosis of syphilis is confirmed, quantitative nontreponemal test titers should be obtained. In pregnant women and patients with neurosyphilis, penicillin remains the only effective treatment option if these patients are allergic to penicillin, desensitization is required before treatment is initiated. Alternative regimens for non-pregnant patients with no evidence of central nervous system involvement include doxycycline, tetracycline, ceftriaxone, and azithromycin. Parenterally administered penicillin G is considered first-line therapy for all stages of syphilis. The diagnosis of syphilis may involve dark-field microscopy of skin lesions but most often requires screening with a nontreponemal test and confirmation with a treponemal-specific test. ![]() Neurosyphilis can develop in any stage of syphilis. Late or tertiary syphilis can manifest years after infection as gummatous disease, cardiovascular disease, or central nervous system involvement. In latent syphilis, all clinical manifestations subside, and infection is apparent only on serologic testing. Primary syphilis typically presents as a solitary, painless chancre, whereas secondary syphilis can have a wide variety of symptoms, especially fever, lymphadenopathy, rash, and genital or perineal condyloma latum. Syphilis is a sexually transmitted disease with varied and often subtle clinical manifestations. ![]()
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