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Clinical Microbiology Reviews, January 2006, p. 29-49, Vol. 19, No. 1
0893-8512/06/$08.00+0     doi:10.1128/CMR.19.1.29-49.2006
Copyright © 2006, American Society for Microbiology. All Rights Reserved.

Biological Basis for Syphilis

Rebecca E. LaFond1 and Sheila A. Lukehart1,2*

Departments of Pathobiology,1 Medicine, University of Washington, Seattle, Washington2

Syphilis is a chronic sexually transmitted disease caused by Treponema pallidum subsp. pallidum. Clinical manifestations separate the disease into stages; late stages of disease are now uncommon compared to the preantibiotic era. T. pallidum has an unusually small genome and lacks genes that encode many metabolic functions and classical virulence factors. The organism is extremely sensitive to environmental conditions and has not been continuously cultivated in vitro. Nonetheless, T. pallidum is highly infectious and survives for decades in the untreated host. Early syphilis lesions result from the host's immune response to the treponemes. Bacterial clearance and resolution of early lesions results from a delayed hypersensitivity response, although some organisms escape to cause persistent infection. One factor contributing to T. pallidum's chronicity is the paucity of integral outer membrane proteins, rendering intact organisms virtually invisible to the immune system. Antigenic variation of TprK, a putative surface-exposed protein, is likely to contribute to immune evasion. T. pallidum remains exquisitely sensitive to penicillin, but macrolide resistance has recently been identified in a number of geographic regions. The development of a syphilis vaccine, thus far elusive, would have a significant positive impact on global health.

* Corresponding author. Mailing address: Department of Medicine, Box 359779, Harborview Medical Center, 325 Ninth Ave., Seattle, WA 98104. Phone: (206) 341-5362. Fax: (206) 341-5363. E-mail: lukehart{at}u.washington.edu.

Clinical Microbiology Reviews, January 2006, p. 29-49, Vol. 19, No. 1
0893-8512/06/$08.00+0     doi:10.1128/CMR.19.1.29-49.2006
Copyright © 2006, American Society for Microbiology. All Rights Reserved.



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