Syphilis—An Elusive Diagnosis

Abstract Increases in the prevalence of syphilis, along with difficulties in recognizing its various clinical presentations, make it an elusive diagnosis. A primary asymptomatic chancre may go unnoticed. Secondary syphilis rash can masquerade as numerous dermatological conditions. Latent syphilis is asymptomatic. Tertiary syphilis can affect the cardiovascular and neurological systems. Failure to correctly diagnose syphilis in its earlier stages leads to dissemination of infection to sexual partners. A positive screening nontreponemal test is confirmed with a treponemal test. Treatment response is monitored by serologic titers. Sexual contacts must be treated. Diagnosis, treatment, and management are presented for 4 stages of syphilis.