Sexual Health

June 2009

FocusSexual Health

Syphilis, the great mimicker, is back

Volume 38, No.6, June 2009 Pages 384-387

Melanie Bissessor

Marcus Y Chen


Syphilis, which had been uncommon in Australian cities until recently, has re-emerged as a major sexually transmissible infection among men who have sex with men.


In this article we review the clinical features and management of syphilis infection, together with measures clinicians can undertake to enhance syphilis control.


Syphilis should be considered in men who have sex with men who present with a rash or anogenital lesions. Men who have sex with men should be serologically screened for syphilis on a regular basis, including those who are HIV infected. Management of syphilis infected individuals should include adequate treatment and efforts to maximise the testing and treatment of sexual partners. Early detection and treatment of syphilis will help control the current syphilis epidemic in Australia among men who have sex with men.

Syphilis is a sexually transmissible infection (STI) caused by the spirochete Treponema pallidum. In recent years, syphilis has re-emerged among men who have sex with men (MSM) in a number of industrialised countries, including Australia, where a substantial proportion of cases have occurred in human immunodeficiency virus (HIV) infected MSM. This has occurred on a backdrop of an increase in HIV notifications and high rates of bacterial STIs such as chlamydia and gonorrhoea among MSM in Australia.1–4 While it is less common among heterosexuals in urban Australia, syphilis remains endemic among some remote indigenous communities and is seen in individuals who have engaged in unprotected sex while overseas.

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