Abstract
Syphilis is a chronic, systemic bacterial infection caused by Treponema pallidum subspecies pallidum, a pathogen recognized as a major public health threat for centuries. Despite the availability of effective antimicrobial therapy, syphilis continues to impose a substantial global burden, with an estimated 5 million new cases reported annually, disproportionately affecting populations in low- and middle-income countries. Objective: This systematic review aimed to synthesize current evidence on the clinical spectrum, epidemiological trends, diagnostic modalities, and treatment strategies of syphilis, with particular emphasis on dermatological manifestations and dermoscopic evaluation. A systematic literature search was conducted across PubMed and Scopus databases using the following search terms: “syphilis,” “diagnosis,” “dermoscopy,” “management and treatment,” “laboratory tests and syphilis,” and “primary OR secondary OR tertiary OR congenital syphilis.” Of 100 articles initially identified, 47 met the predefined inclusion criteria and were incorporated into the final analysis. The review synthesized evidence on the full clinical spectrum of primary, secondary, tertiary, and congenital syphilis, with detailed characterization of cutaneous manifestations and dermoscopic features. Established and emerging diagnostic modalities were systematically evaluated with respect to their diagnostic accuracy and alignment with current clinical guidelines. Treatment and management strategies across all disease stages were critically appraised in accordance with applicable international guidelines. Syphilis represents a resurgent global public health challenge demanding strengthened advocacy, sustained community engagement, and increased research investment. Priority areas include the advancement of point-of-care diagnostics, the development of reliable treatment-response biomarkers, the reinforcement of public health surveillance infrastructure, and, ultimately, the development of an effective preventive vaccine.
Keywords: Syphilis; Epidemiology; Diagnosis; Treatment