Current Trends in Syphilis Testing

During lunch I attended a Roche sponsored integrated symposium titled ´Syphilis, Chlamydia, Gonorrhoea-Oh My: Diagnostic Advances, Hurdles and Considerations.

I used this opportunity to get a refresher on syphilis considering the rates we are experiencing in North Queensland and to see whether trends/testing/management vary in other parts of the world. It was a very informative talk and definitely made me consider other presentations of syphilis i.e chancres in non-genital sites ( fingers, tonsils etc).

Dr Marco Cusini of the University of Milan, Italy presented ´Current Trends in Syphilis Testing´. The landscape of syphilis in 2017 is that it is well and truly still present and a major public health problem. Late syphilis is rare in Europe but early syphilis still very prominent. Thankfully it is still highly sensitive to penicillin G. In terms of clinical diagnosis, syphilis can be difficult as it is `the great imitator´. Sites of the primary lesion can be extra-genital (and unusual locations), the morphology of lesions can be challenging and there may be a number of primary lesions. Occular involvement also needs to be remembered! 

The diagnosis of syphilis can be achieved through direct methods if lesions are present. This is a quick and in-expensive method but only useful if used under expert eyes. NAATs have the highest sensitivity and specificity. Serology needs always to be performed to confirm the diagnosis and for ongoing disease follow-up. 

Point of care testing are useful in developing countries and there is one FDA approved test. POC testing for syphilis shows good specificity and sensitivity but Dr Cusini stated that they were not really a substitute for serological testing if laboratory facilities are available.

Lumbar punctures need to be considered in anyone demonstrating signs or symptoms of neurosyphilis or demonstrating occular involvement.

Adequate response after treatment was discusssed. Generally an adequate response after treatment for active syphilis is considered a 4 titre decrease at six months. It was good to hear that at our clinic we follow similar guidelines.

Dr Cusini referred to the 2014 European Guidelines for the Management of Syphilis (Janier. et al, 2014) for further information regarding diagnosis and management. It is easily found on the web should anyone wish to read it.

Definitely a good refresher on syphilis and an interesting lecture.