Syphilis

Abstract

This article provides an overview of the history, epidemiology and clinical features of syphilis, a sexually transmitted infection caused by Treponema pallidum subspecies pallidum. It traces the first recorded European outbreak in Naples in the late 15th century and examines the disease's persistent stigma, protean clinical presentations and significant public health impact. The narrative details fluctuations in the incidence of syphilis, highlighting major increases after both World Wars, the introduction of penicillin and public health campaigns in the 1940s, and the resurgence among men who have sex with men in the 1960s and again after the advent of effective HIV treatments in the 1990s. Recent trends underscore rising infection rates in England, including among heterosexual individuals and a concerning increase in congenital syphilis linked to late antenatal care and missed diagnoses. The document also summarizes the clinical stages of syphilis, underscoring the importance of early recognition and treatment to prevent severe complications, and the importance of testing, access to services and partner notification plus innovations such as doxycycline post-exposure prophylaxis to prevent infection.