Syphilis remains a pressing public health problem globally across different populations including men who have sex with men and pregnant women. It is timely to review what international surveillance data tell us and the evidence behind public health interventions aimed at controlling syphilis. A reinvigorated response to the re-emergence of syphilis is required.

This manuscript provides an overview of the evolution of the global syphilis epidemic among men who have sex with men (MSM). It chronicles the changes in syphilis epidemiology among MSM including its interface with the HIV/AIDS epidemic. Finally, it seeks to describe the recent resurgence of syphilis incidence in the 2000s among MSM after a prior sharp drop in cases in the 1990s and calls for innovative strategies to address the evolving epidemic.

Syphilis remains widespread worldwide, with increasing rates among men who have sex with men.  This paper reviews available evidence regarding syphilis transmission, and discusses how key prevention interventions, such as syphilis screening and treatment, condoms, and risk-reduction counselling modify syphilis transmission dynamics.

HIV-1 infected men who have sex with men (MSM) are disproportionately affected by syphilis in many higher income countries. Anal and oral intercourse may lead to transmission and primary ulcers at non-genital sites which go unrecognised. Moreover, the manifestations of symptomatic disease, especially neurosyphilis, may be altered by HIV-1. This review provides a summary of the clinical features of early syphilis (primary, secondary and early neurological involvement) and the ways in which these may be modified by HIV-1 infection in MSM.

This review explores the advances and utility of rapid point-of-care tests for syphilis using the World Health Organizations’ ASSURED criteria.

Syphilis control strategies are old, but interventions have changed and there is now a more scientific approach to evidence of effectiveness. A review of the literature found few papers used high-quality research methodology and fewer evaluated impact on prevalence or incidence; most assessed intermediate outcomes. Syphilis can often be controlled by a combination of case finding, treatment and education. However, outbreaks are unique and ongoing evaluation is needed to see if interventions are producing intended intermediate outcomes at reasonable costs.

We explore the controversies that exist around the management of syphilis in HIV-positive individuals. The optimal antimicrobial regimen to treat syphilis in HIV is unknown due to a lack of randomised controlled trial data. We discuss the factors associated with poorer serological outcomes whereby enhanced antibiotic therapy, which penetrates the central nervous system, may be of benefit.

Syphilis is a re-emerging sexually transmitted disease that, within the last few decades, has been on the rise globally. Treponema pallidum subspecies pallidum, the causative agent of syphilis, displays a substantial amount of interstrain diversity. These variants have been identified in various parts of the world, indicating transmission linkage between geographical regions. This review will highlight the genetic variation within Treponema pallidum strains, the methods utilized for genotyping, and the linkage between genetically distinct organisms and bacterial pathogenesis.

This paper examines the male and female syphilis notification rates in high-income countries from 2000 to 2013. The male to female ratio and proportion of cases reported as being in men who have sex with men is calculated. This paper shows that in countries with high income, there is a near universal finding of increasing rates of syphilis in MSM. It is therefore clear that no country has identified an effective method to control syphilis in this population.

During 2012, Christchurch, New Zealand experienced a dramatic increase in cases of infectious syphilis among men who have sex with men. In 2012, 26 males and no females were diagnosed and of these 26, 22 reported only sex with men. The use of social is discussed.

Syphilis incidence in HIV-Positive men who have sex with men (MSM) continues to rise, however there remains barriers to enhanced testing schedules. We demonstrate an increase in syphilis testing of HIV-positive patients and a three-fold increase in new syphilis diagnoses following a period of enhanced syphilis testing in HIV-positive MSM.

After a local syphilis outbreak, this study examines the rates of syphilis testing, syphilis infection and characteristics of those with syphilis among adolescents and young adults at a teen health clinic in Cincinnati, Ohio. In addition, the study explores the agreeability of syphilis staging and treatment between chart documentation and reviewers according to the Centers for Disease Control and Prevention Guidelines.