title: Syphilis testing, typing, and treatment follow-up: a new era for an old disease.
abstract: OBJECTIVE
  The past 15 years have seen a dramatic increase in syphilis diagnoses in several regions including China, North America, Western Europe and Australia. Worldwide, the disease remains prevalent, contributing to substantial adult morbidity and neonatal mortality. Testing and treatment strategies are largely informed by data from the early antibiotic era, but increasing use of molecular diagnostics and new screening strategies could improve the management of syphilis substantially.
  
  
  RESULTS
  The review explores new testing strategies for syphilis, including the importance of screening test selection and advances in point-of-care diagnostics. It then examines molecular studies of Treponema pallidum, covering typing; macrolide resistance; association between genotype and phenotype and the use of PCR in testing and monitoring strategies.
  
  
  CONCLUSIONS
  Clinicians should be aware of testing strategies employed by their laboratories to ensure optimal sensitivity and specificity. Locally available T. pallidum PCR assays may improve the diagnosis of early disease and inform antibiotic choice. Robust serologic follow-up is still required, but predictors of potential treatment failure, including PCR-measured bacterial load, have been identified. Re-treatment should be considered for patients in the serofast state. The publication of T. pallidum genomes would allow further and more detailed study of strains and disease pathogenesis.
authors.affiliation: aImperial College Healthcare NHS Trust, Jefferiss Wing, St Mary's Hospital bSection of Retrovirology and Genito-urinary Medicine, Department of Medicine, Imperial College London, Norfolk Place, London, UK.
authors.forename: Craig
authors.initials: C
authors.lastname: Tipple
authors.forename: Graham P
authors.initials: GP
authors.lastname: Taylor
mesh_terms: D000900:Anti-Bacterial Agents / Q000008:administration & dosage* / Q000494:pharmacology; D004269:DNA, Bacterial / Q000235:genetics*; D024881:Drug Resistance, Bacterial / Q000187:drug effects / Q000235:genetics*; D005500:Follow-Up Studies; D005838:Genotype; D018942:Macrolides / Q000008:administration & dosage* / Q000494:pharmacology; D008403:Mass Screening; D058889:Molecular Typing; D019095:Point-of-Care Systems; D016133:Polymerase Chain Reaction; D013587:Syphilis / Q000175:diagnosis* / Q000188:drug therapy / Q000235:genetics; D013588:Syphilis Serodiagnosis; D014210:Treponema pallidum / Q000302:isolation & purification*
chemical_list: D000900:Anti-Bacterial Agents; D004269:DNA, Bacterial; D018942:Macrolides