Question 1

What is syphilis?

Accepted Answer

Syphilis is a bacterial sexually transmitted infection caused by Treponema pallidum — transmitted through direct contact with a syphilitic sore (chancre) during sexual contact, or from mother to fetus (congenital syphilis). It is a multistage disease: primary (painless genital, anal or oral ulcer); secondary (rash, mucous patches, flu-like illness); latent (silent infection); and tertiary (cardiovascular, neurological, gummatous disease — years after initial infection). Historically known as "the great imitator" because it can mimic almost any other disease.

Question 2

Why is congenital syphilis resurging?

Accepted Answer

The US congenital syphilis epidemic — rising 10-fold between 2014-2022 to nearly 4,000 cases — reflects several failures: inadequate prenatal care (cases disproportionately affect women without prenatal care); rising syphilis rates in women of reproductive age; social determinants (poverty, substance use, housing instability); penicillin supply shortages; and failure of health systems to screen and treat pregnant women early. Every congenital syphilis case represents a preventable tragedy — antenatal screening and benzathine penicillin treatment in the first half of pregnancy prevents virtually all cases.

Question 3

How is syphilis diagnosed?

Accepted Answer

Two-stage serology: (1) Non-treponemal tests (RPR or VDRL — quantitative; used for screening and treatment monitoring; titre declines with successful treatment; can be false positive). (2) Treponemal tests (TPHA, TPPA, FTA-ABS, or rapid treponemal point-of-care tests — specific confirmatory; remain positive for life after treated infection — cannot distinguish active from past infection). Active syphilis: positive non-treponemal + confirmed treponemal. For neurosyphilis: CSF VDRL + CSF pleocytosis.

Question 4

How is syphilis treated?

Accepted Answer

Benzathine penicillin G is the treatment of choice for all stages — remarkably T. pallidum has developed no penicillin resistance in over 80 years. Primary, secondary, early latent (<1 year): single IM injection of benzathine penicillin 2.4 MU. Late latent (>1 year) or unknown duration: 3 weekly IM injections (2.4 MU each). Neurosyphilis: IV benzylpenicillin (18-24 MU/day for 10-14 days). Penicillin allergy: doxycycline (not in pregnancy — must desensitise). HIV-positive patients: same treatment; monitor response carefully (serology may be atypical).

Question 5

Is syphilis present in Georgia?

Accepted Answer

Yes — Georgia, like most countries, has active syphilis transmission, with rates varying by region and risk group. Men who have sex with men (MSM) bear a disproportionate burden globally. Antenatal syphilis screening is WHO-recommended and part of Georgia's prenatal care programme. PHIG monitors STI trends including syphilis. Awareness among clinicians of syphilis's varied presentations — from genital ulcer to stroke in a young person — is important given the great imitator's diagnostic challenge.

Question 6

How does GMJ News cover syphilis?

Accepted Answer

GMJ News covers WHO syphilis burden data, the US congenital syphilis resurgence, two-stage serology, benzathine penicillin treatment, neurosyphilis management, and the syphilis-HIV connection. Syphilis represents one of the oldest and most persistent infectious diseases — with a thoroughly modern resurgence that demands renewed attention.

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