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  1. D A Lewis1,
  2. H Young2
  1. 1STI Reference Centre, National Institute for Communicable Diseases, Johannesburg, South Africa
  2. 2STD/Chlamydia Laboratory, Department of Laboratory Medicine (Microbiology), Edinburgh Royal Infirmary, Edinburgh, UK
  1. Correspondence to:
 Dr David A Lewis
 STI Reference Centre, National Institute for Communicable Diseases, Private Bag X4, Sandringham, 2131, South Africa; davidl{at}

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Syphilis, caused by infection with Treponema pallidum subspecies pallidum, is a mucocutaneous sexually transmitted infection (STI) with high infectivity in the early infectious stages. It may also be passed transplacentally from the ninth week of gestation onwards. The primary stage, with an incubation period of 9–90 days, usually consists of a painless single ulcer at the site of inoculation that may be accompanied by regional lymphadenopathy. The secondary stage, with an incubation period of 6 weeks to 6 months, has many clinical manifestations including rash, mouth ulcers, condylomata lata, patchy alopecia, generalised lymphadenopathy, meningitis, and hepatitis. The later, non-infectious, tertiary stage manifestations of syphilis are now rarely seen in the United Kingdom and include gummatous syphilis, neurosyphilis, and cardiovascular syphilis. Latent syphilis may be divided into early (less than 2 years’ duration) and late (more than 2 years’ duration).

Screening is recommended for all asymptomatic patients attending a UK genitourinary medicine (GUM) clinic.

There are no controlled studies to support this statement but the recent increase in infectious syphilis in the United Kingdom and other European countries1 supports screening as part of good clinical practice. Apart from the public health benefit of detecting infectious syphilis, screening will detect non-infectious stages of syphilis, which will benefit the individual patient.

Patients with syphilitic lesions will require further investigation as outlined below.


Serological screening tests

Treponema pallidum enzyme immunoassay (EIA) (evidence level IIb; recommendation grade B)

There are a number of different EIAs to detect anti-treponemal antibodies and very few have been subject to peer review evaluation so it is important to establish satisfactory performance of any EIA used; this applies to all types of serological test.

EIAs that detect both IgG and IgM are recommended as they tend to be more sensitive in primary infection2,3 (evidence level IIb; recommendation grade B). …

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  • Conflicts of interest: none.