title: The immunopathobiology of syphilis: the manifestations and course of syphilis are determined by the level of delayed-type hypersensitivity.
abstract: Syphilis has plagued mankind for centuries and is currently resurgent in the Western hemisphere. Although there has been a significant reduction of tertiary disease and recognition of facilitative interactions with human immunodeficiency virus infection, the natural history of syphilis has remained largely unchanged; thus, new strategies are required to more effectively combat this pathogen. The immunopathologic features of experimental syphilis in the rabbit; the course, stages, and pathology of human syphilis; and a comparison of human syphilis with leprosy suggest that the clinical course of syphilis and its tissue manifestations are determined by the balance between delayed-type hypersensitivity (DTH) and humoral immunity to the causative agent, Treponema pallidum. A strong DTH response is associated with clearance of the infecting organisms in a well-developed chancre, whereas a cytotoxic T-cell response or strong humoral antibody response is associated with prolonged infection and progression to tertiary disease. Many of the protean symptoms/appearances of secondary and tertiary human syphilis are manifestations of immune reactions that fail to clear the organism, due to a lack of recruitment and, more importantly, activation of macrophages by sensitized CD4 T cells. The Bacillus Calmette-Guerin vaccination can enhance DTH and has been shown to produce a low, but measurable, beneficial effect in the prevention of leprosy, a disease that shows a disease spectrum with characteristics in common with syphilis. In the prevention of syphilis, a potential vaccine protective against syphilis should be designed to augment the DTH response.
authors.affiliation: Divisions of Dermatopathology and Dermatology, Department of Pathology, Albany Medical College, Albany, NY, USA.
authors.forename: J Andrew
authors.initials: JA
authors.lastname: Carlson
authors.forename: Ganary
authors.initials: G
authors.lastname: Dabiri
authors.forename: Bernard
authors.initials: B
authors.lastname: Cribier
authors.forename: Stewart
authors.initials: S
authors.lastname: Sell
mesh_terms: D000818:Animals; D006801:Humans; D006968:Hypersensitivity, Delayed / Q000276:immunology*; D013587:Syphilis / Q000276:immunology* / Q000473:pathology*