Dermatologic and systemic manifestations of syphilis.

The incidence of syphilis is increasing, predominantly among urban heterosexuals. Early recognition is important in preventing progression of the disease and transmission of Treponema pallidum to the fetus. Untreated primary syphilis is characterized by intervals of active disease punctuated by periods of latency. Not all patients progress through each phase, and the physician must be alert to varying presentations. Cutaneous lesions are the hallmark of syphilis. However, diagnosis can be difficult, because the lesions can be asymptomatic or transient. The course of syphilis is accelerated in patients infected with the human immunodeficiency virus, and these patients frequently exhibit atypical lesions. The incidence of congenital syphilis is increasing, and efforts to control fetal morbidity depend on prompt recognition and treatment of infection during pregnancy. The definitive diagnosis of any stage of syphilis is based on historical and clinical findings supported by serologic testing.