1. Syphilis in the United States: An Update for Clinicians With an Emphasis on HIV Coinfection 
Nicola M. Zetola, MD, Joseph Engelman, MD, Trevor P. Jensen, Jeffrey D. Klausner, MD, MPH 
Mayo Clinic Proceedings 
Volume 82, Issue 9, Pages (September 2007)
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2. FIGURE 1
Multiple chancres seen in patients with human immunodeficiency virus presenting with primary syphilis.
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3. FIGURE 2 Typical chancre of primary syphilis.
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4. FIGURE 3
Mucous patches confused with oral candidiasis in a patient with human immunodeficiency virus.
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5. FIGURE 4 Secondary syphilis.
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6. FIGURE 5
Diagnostic algorithm based on serological test results. Fluorescent treponemal antibody absorption test is another treponemal assay often used. A rapid plasma reagin (RPR) or VDRL titer of 1:16 or greater suggests infection in the prior year. TPPA = Treponema pallidum particle agglutination.
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7. FIGURE 6
Evaluation of serological treatment response algorithm. CSF = cerebrospinal fluid; HIV = human immunodeficiency virus.
*Treatment failure may be caused by untreated neurosyphilis.
†Reinfection may be consistent with a 4-fold serological titer decline followed by a 4-fold serological titer increase and reexposure. Treat with pencillin G benzathine, 2.4 million units intramuscularly once.
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