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temperature to 101 to 102F, with reactions occurring within 12 h of initiation of treatment and terminating within. Pallidum is a spirochete varying from.10.18 m in diameter and from 6 to 20 m in length, making it invisible by light microscopy ( 245, 360 ). Systemic symptoms associated with secondary syphilis range from slight malaise to prostration and cachexia ( 324 ). Reviews of the limited studies in the treatment of late latent syphilis have deemed them inadequate to determine an optimal treatment regimen ( 168, 370 ). Extragenital chancres occur infrequently; in recent series they have been reported in less than 2 of patients ( 224 ). (a) Primary and secondary syphilis. Other high-risk groups in which routine screening is justifiable and may be central to syphilis control efforts include populations in correctional facilities ( 23, 145 drug users in emergency rooms ( 82 and patients suspected of having STDs other than syphilis ( 83, 306 ).

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Concurrent infection with HIV was not associated with the isolation. About 90 of first relapses occur within 1 year, 94 occur within 2 years, and the rest occur over 4 years ( 115 ). Mass treatment of populations with a high prevalence of infection has also been effective; for example, treatment of commercial sex workers in Fresno, Calif., in 1977 interrupted an epidemic of syphilis ( 171 ). It has been suggested that the syphilis epidemics of the 1980s and 1990s are the result of core transmission ( 254 ). Due to the high cost, this approach will probably have to be used more selectively in the future ( 322 ). A series of studies by Fiumara involving a total of 588 patients with primary syphilis and 623 with secondary syphilis demonstrated that all patients with primary syphilis seroreverted their nontreponemal tests within 1 year while all with secondary syphilis seroreverted within 2 years (. However, recent bacteriological work has demonstrated genetic differences between these organisms ( 44 ). Pallidum genome contains 57 ORFs (5 of the total) that encode 18 distinct transporters specific for amino acids, carbohydrates, and cations. Benzathine penicillin is not recommended, since it does not achieve detectable levels in the CSF ( 226, 264 ). With successful therapy, the cell count should return to normal within 6 months and should be followed by a decrease in the protein level and finally a decline in the quantitative CSF vdrl, which can remain reactive for more than 1 year after treatment (.