JAMA Clinical Reviews What Clinicians Should Know About Syphilis
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Oct 16, 2025 Franco Chevalier, an infectious disease physician and Deputy Medical Director at the San Francisco City Clinic, dives into the alarming rise of syphilis cases in the U.S. He discusses the serious complications of untreated syphilis, including potential blindness and dementia. Chevalier outlines effective serologic testing strategies, illuminates when to consider lumbar punctures for neurosyphilis, and talks about emerging rapid testing options. He emphasizes the importance of early treatment with penicillin and the latest prevention guidelines, reminding clinicians of syphilis's complex clinical presentations.
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Rising Burden And Severe Consequences
- Syphilis diagnoses in the US have risen dramatically from <10,000 cases in 2000 to over 53,000 primary and secondary cases in 2023.
- Untreated syphilis can cause blindness, deafness, cognitive impairment, and congenital infection, highlighting major morbidity.
Combine Serology With Clinical Context
- Use serologic testing plus clinical evaluation because Treponema pallidum cannot be cultured in routine labs.
- Correlate treponemal and non-treponemal tests with history and prior results to determine new versus treated infection.
Watch For Reverse Algorithm Pitfalls
- If you use the reverse algorithm, start with a treponemal EIA and then obtain a non-treponemal test to assess activity.
- If clinical suspicion is high and RPR is nonreactive, perform serial dilutions to detect the prozone phenomenon.