Nicola M. Zetola, MD, Joseph Engelman, MD, Trevor P. Jensen, Jeffrey D

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Syphilis in the United States: An Update for Clinicians With an Emphasis on HIV Coinfection Nicola M. Zetola, MD, Joseph Engelman, MD, Trevor P. Jensen, Jeffrey D. Klausner, MD, MPH Mayo Clinic Proceedings Volume 82, Issue 9, Pages 1091-1102 (September 2007) DOI: 10.4065/82.9.1091 Copyright © 2007 Mayo Foundation for Medical Education and Research Terms and Conditions

FIGURE 1 Multiple chancres seen in patients with human immunodeficiency virus presenting with primary syphilis. Mayo Clinic Proceedings 2007 82, 1091-1102DOI: (10.4065/82.9.1091) Copyright © 2007 Mayo Foundation for Medical Education and Research Terms and Conditions

FIGURE 2 Typical chancre of primary syphilis. Mayo Clinic Proceedings 2007 82, 1091-1102DOI: (10.4065/82.9.1091) Copyright © 2007 Mayo Foundation for Medical Education and Research Terms and Conditions

FIGURE 3 Mucous patches confused with oral candidiasis in a patient with human immunodeficiency virus. Mayo Clinic Proceedings 2007 82, 1091-1102DOI: (10.4065/82.9.1091) Copyright © 2007 Mayo Foundation for Medical Education and Research Terms and Conditions

FIGURE 4 Secondary syphilis. Mayo Clinic Proceedings 2007 82, 1091-1102DOI: (10.4065/82.9.1091) Copyright © 2007 Mayo Foundation for Medical Education and Research Terms and Conditions

FIGURE 5 Diagnostic algorithm based on serological test results. Fluorescent treponemal antibody absorption test is another treponemal assay often used. A rapid plasma reagin (RPR) or VDRL titer of 1:16 or greater suggests infection in the prior year. TPPA = Treponema pallidum particle agglutination. Mayo Clinic Proceedings 2007 82, 1091-1102DOI: (10.4065/82.9.1091) Copyright © 2007 Mayo Foundation for Medical Education and Research Terms and Conditions

FIGURE 6 Evaluation of serological treatment response algorithm. CSF = cerebrospinal fluid; HIV = human immunodeficiency virus. *Treatment failure may be caused by untreated neurosyphilis. †Reinfection may be consistent with a 4-fold serological titer decline followed by a 4-fold serological titer increase and reexposure. Treat with pencillin G benzathine, 2.4 million units intramuscularly once. Mayo Clinic Proceedings 2007 82, 1091-1102DOI: (10.4065/82.9.1091) Copyright © 2007 Mayo Foundation for Medical Education and Research Terms and Conditions