Current Trend on Syphilis Diagnosis: Issues and Challenges

  • Muhammad G. MorshedEmail author
Conference paper
Part of the Advances in Experimental Medicine and Biology book series (AEMB, volume 808)


Syphilis is a century old sexually transmitted infection transmitted worldwide. WHO reports 12 million new cases that were identified in 1999, with over 90 % of these infections reported from patients from low-income countries. This case number of syphilis is on the rise globally in the Men have sex with Men (MSM) population. Dark field microscopy (DFM) and direct fluorescence assay (DFA) have been used in clinical laboratories for decades to demonstrate Treponema pallidum in acutely infected human tissue and/or body fluids. Molecular technologies allow detecting T. pallidum and also determine drug resistance (by identifying DNA point mutation). It is evident from the published literature that PCR is useful as an adjunct test to DFA and DFM, and is useful in confirming syphilis in genital ulcer, tissue, and other body fluid samples, providing even more sensitive detection algorithm. Serological tests remain the mainstay tests since T. pallidum is nonculturable and also because blood collection is easy. The practice of serological testing is changing rapidly from traditional nontreponemal screening followed by confirmatory treponemal testing to screening by treponemal tests referred to as “Reverse Algorithm” followed by nontreponemal testing to determine active infections. Special and further complex algorithms are essential to deal with complex issues such as neurosyphilis or congenital syphilis. Due to the huge surge of syphilis in developing countries where access to medical care is not optimal, point of care or rapid tests may play an important role. This author took an attempt to summarize the current trend of syphilis diagnosis and challenges from a global perspective.


Syphilis Treponema pallidum Serology Diagnosis Detection 



Thanks are due to Dr. Hugh Jones MD, Diploma in Venerology (UK) for his review and critical reading of this manuscript; Dr. Christina Marra for providing neurosyphilis and congenital syphilis algorithms and Dr. Richard Lester for providing Canadian syphilis data.


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Copyright information

© Springer India 2014

Authors and Affiliations

  1. 1.Department of Pathology and Laboratory Medicine, Faculty of MedicineUniversity of British Columbia; BC Public Health Microbiology and Reference Laboratory, Provincial Health Services AuthorityVancouverCanada

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