[Clinical presentation of syphilis].

Since the turn of the millennium, the incidence of syphilis is on the rise in France and in other developed countries. The majority of syphilis cases currently occur in men having sex with men and half of the cases occur in HIV-positive patients. Multiple partners and non protected intercourses are frequently reported. About 80% of syphilis recently diagnosed in France are symptomatic and correspond to primary or secondary syphilis. The other potential circumstances of diagnosis of syphilis include the presence of risk factors, an intercourse with an infected partner, the serological follow-up of a previous syphilis and a systematic screening during pregnancy. Clinical features are mainly represented by skin and mucosal lesions. However, extra-cutaneous involvement and biological abnormalities are quite frequent during secondary syphilis especially ophthalmic complications which are source of sequelae due to the delay for diagnosis. In the post-HAART era, it seems that clinical presentation and serological response after treatment is similar in HIV infected patients in comparison to HIV uninfected patients and that patients with early syphilis shoud be treated with one dose of benzathine penicillin G while the unique treatment for neurosyphilis is intravenous penicilline G.