Syphilis—An Elusive Diagnosis

Published:November 09, 2021DOI:


      • Secondary syphilis can be misdiagnosed as other dermatological conditions.
      • Intramuscular penicillin G benzathine, 2.4 million units, is the recommended treatment.
      • All pregnant women should be screened for syphilis.
      • All individuals who test positive for syphilis should be tested for HIV.
      • Because syphilis is a communicable disease, all cases are reportable to the local health department.


      Increases in the prevalence of syphilis, along with difficulties in recognizing its various clinical presentations, make it an elusive diagnosis. A primary asymptomatic chancre may go unnoticed. Secondary syphilis rash can masquerade as numerous dermatological conditions. Latent syphilis is asymptomatic. Tertiary syphilis can affect the cardiovascular and neurological systems. Failure to correctly diagnose syphilis in its earlier stages leads to dissemination of infection to sexual partners. A positive screening nontreponemal test is confirmed with a treponemal test. Treatment response is monitored by serologic titers. Sexual contacts must be treated. Diagnosis, treatment, and management are presented for 4 stages of syphilis.


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      Donna Gullette, PhD, AGACNP-BC, is associate dean for practice, College of Nursing, University of Arkansas for Medical Sciences, Little Rock, AK, and can be contacted at [email protected] .


      Karmen Hopkins, MD, is a family practice physician, Little Rock, AK.