Regardless of origins, syphilis has affected Europeans over many centuries. The first well-documented outbreak occurred in Naples in 1494, rapidly swept throughout Europe and was associated with a myriad of presenting signs and symptoms and a high mortality rate.1 The condition was once a leading cause of dementia and in the pre-antibiotic era caused one out of five of all admissions to psychiatric institutions in the USA.2 In 1943 Mahoney and co-workers first treated cases of syphilis with penicillin. This drug has remained the mainstay of treatment since that time.3

TRANSMISSION

Horizontal transmission among adolescents and adults is primarily sexual, although anecdotal reports cite kissing, contact with infected secretions and blood transfusion as potential sources of acquisition and transmission.4

Transmission to the fetus is usually via the placenta, but may occur during delivery in the presence of maternal genital lesions. The risk of vertical transmission of syphilis from an infected untreated mother decreases as maternal disease progresses, ranging from 70–100% for primary syphilis and 40% for early latent syphilis to 10% for late latent disease (early and late latent syphilis occurring less than or more than 1 year after initial infection in adults, respectively).3 5 Although unusual, transmission to newborns from mothers with tertiary syphilis has also been reported.6 Thus, the longer the interval between infection and pregnancy, the more benign is the outcome in the infant (Kassowitz’s law).6

EPIDEMIOLOGY

Syphilis is common in the developing world with localised prevalence in pregnant women varying widely from 2.5% in Burkina Faso to 17.4% in Cameroon.7 However, such data may be skewed by high numbers of false-positive assays.

Data on sexually transmitted infections have been collected in the UK since 1917; such infections are currently reported by genitourinary medicine (GUM) clinics to the Health Protection Agency …