ABSTRACT
With rising syphilis and congenital syphilis rates in the United States and globally, clinicians who may not have seen or diagnosed syphilis in training are now faced with recognition of myriad symptoms of the “great masquerader” and interpretation of diagnostic algorithms that can be perplexing. Screening for syphilis at the first prenatal visit, in the third trimester, and at delivery is now recommended by the American College of Obstetricians & Gynecologists. Although increased screening improves detection of asymptomatic (latent) infection, there is also potential for overtreatment or misdiagnosis. This report serves to familiarize clinicians with symptomatic manifestations of primary and secondary syphilis, to assist with correct interpretation of traditional and reverse algorithms, and to inform clinical staging to maximize the likelihood of adequate and timely treatment. Prompt and accurate public health reporting is discussed to facilitate prioritization of partner services. Additional guidance is provided for clinicians whose laboratories plan a transition from traditional to reverse-sequence screening for syphilis, with focused review of management of the obstetric patient with discordant screening tests.