Pathogenesis: Syphilis is caused by the spirochete, T. pallidum pallidum. This bacteria is highly infective and is predominantly spread by sexual contact and by transmission from an infected mother to her unborn child.
Treatment: The T. pallidum organism has very little antibiotic resistance, and the therapy of choice is still penicillin. A single intramuscular dose of 2.4 million IU of benzathine penicillin G is recommended, and some now recommend a follow-up dose—the same as the initial dose—at 1 or 2 weeks. Patients who develop neurosyphilis need to be treated with intravenous penicillin for at least 2 weeks. Most patients who are treated for syphilis develop the Jarisch-Herxheimer reaction. This reaction is the result of the decimation of the T. pallidum organisms due to therapy with penicillin. As the scores of bacteria are killed, the dead spirochetes induce an inflammatory reaction. This reaction may manifest as fever, chills, fatigue, malaise, and rashes of varying morphology. It can often make the rash of secondary syphilis appear worse for a period of time. This reaction is not specific to T. pallidum and has been reported with other infectious agents. It is critical to follow patients long enough after therapy ensure adequate treatment as measured by titers on rapid plasma reagin (RPR) or venereal disease research laboratory (VDRL) testing. All patients with syphillis should be tested for HIV.
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