Syphilis

Syphilis, caused by the spirochaete Treponema pallidum is an old disease. Many notable figures throughout history are thought to have suffered from this scourge. It remains exquisitely sensitive to penicillin so, in theory, should be easily treatable. Over the past two years, the number of notified cases of infectious syphilis – syphilis of less than two years' duration — has continued to grow. In the Northern Territory and Queensland, the emerging risk groups are young Aboriginal and Torres Strait Islanders (ATSI), particularly people from the north of the State. In this group, in which young females are infected, there is now a real risk of new cases of congenital syphilis. In other geographical areas, gay and bisexual males form the major risk group. Co-infections with other sexually transmitted infections (STIs) are common and should always be tested for simultaneously. Similarly, all STI screens should include a test for syphilis. At-risk patients require screening for co-existing chlamydia, gonorrhoea and/or and trichomonas if the patient belongs to the ATSI group. Screening for HIV, hepatitis A, B and C should also occur, with hepatitis A and B vaccination in those who are non-immune. The recommended regular screening for asymptomatic gay and bisexual males is outlined in the now renamed STIGMA guidelines (http://stipu.nsw.gov.au/wp-content/uploads/STIGMA_Testing_Guidelines_Final_v5.pdf).

Presentation

Early or infectious syphilis (less than two years' duration) includes primary, secondary and early latent syphilis (Algorithms 1 and 2). • Primary syphilis usually manifests as a chancre (an anogenital or, less commonly, extragenital painless, but also sometimes painful, ulcer with indurated edges). • Progression to secondary syphilis occurs over the following months and presents as an acute systemic illness with rash, which is usually truncal, but also involving palms and soles, condylomata lata (clusters of soft, moist lumps in skin folds of the anogenital area), mucosal lesions, alopecia, lymphadenopathy, hepatitis, or meningitis. • Early latent syphilis is infection of less than two years' duration where the patient is asymptomatic. Late latent syphilis is defined as latent (asymptomatic) syphilis of longer than two years' duration, or of unknown duration. Tertiary syphilis refers to syphilis of longer than two years' duration, or of unknown duration, with cardiovascular, central nervous system or skin and bone (gummatous syphilis) involvement. Risk of transmission of syphilis from a pregnant mother to her fetus depends on the stage of syphilis during pregnancy. Management is clearly outlined in the ASID Management of Perinatal Infections Guidelines (https://www.asid. net.au/documents/item/368)

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General Practice Pathology is a new regular column each authored by an Australian expert pathologist on a topic of particular relevance and interest to practising GPs. The authors provide this editorial, free of charge as part of an educational initiative developed and coordinated by Sonic Pathology.