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In order to describe the trend of syphilis at the Infectious Diseases Clinic of Perugia University, Italy, over a six-year period (2005-2010), 138 patients were identified and monitored. Syphilis diagnosis was as follows: latent 60%, secondary 21%, neurosyphilis 10%, primary 9%. The study population comprised 83% males, 59% Italians and 45% men who have sex with men (MSMs). Heterosexual females represented 28.5% cases among immigrants and 8.5% cases among Italians, while men with unknown sexual contacts were 28% and 14% respectively (p=0.0059). HIV co-infection was detected in 70% of patients, with a predominance of males (94%) and Italians (62%). Among HIV-positive patients, 63% were pre-existing HIV-infected: of these, 26% had primary or secondary syphilis. During the study period, the number of regional syphilis notifications at the Italian Health Department was lower with respect to the observed cases at the Infectious Diseases Clinic of Perugia (69 versus 138). Globally, the trend of syphilis infection remained stable over the six-year period. However, efforts to improve prevention and screening programs are required for persons at risk of both syphilis and HIV infection, as well as measures to strengthen syphilis notification procedures.

The antigenic structure of Treponema pallidum was described in the 1940s and 1950s. The main contributions of Giuseppe D'Alessandro and his collaborators included the description of the external membrane and of the polysaccharide antigen found in the cell wall of the microorganism. Based on new knowledge it has been possible to develop diagnostic tests that are more sensitive and specific than nontreponemal tests, which nevertheless retain their validity in the current re-emergence of syphilis as a public health problem.

The authors considered psychological problems concerning the communication to patients about a diagnosis of Sexual Transmitted Disease and particularly of HPV disease. In the past this sort of affection was related to some well identified social groups, but with the recent changes in sexual behavior, cultural and moral principles, the reference models are changed too. Consequently today it is difficult to recognize a rigid identification. However it is still possible that during the communication of the diagnosis the physician unconsciously transfers to the patient "his" classification with a given model among the groups of STD affected. This is particularly true for the gynecologist that is reporting on HPV infection or disease. Therefore the physician has to pay a great attention to the way he communicates, because in addition to the clinical concept there are psychological effects on the patient and on her relationships that could result iatrogenic.

The results of electroimmunodiffusion investigations with Reiter treponema antigen and syphilitic subject sera are presented. Counter-immunoelectrophoresis, rocked electrophoresis and crossed-electrophoresis studies have been performed. The test positivity is shown by the appearance of one ore two precipitates. No aspecificities were remarked with the latter two techniques: particular attention was devoted to the preparation of the treponema antigen in the attempt to eliminate the aspecificity which, sometimes, occurs above all with counter immuno-electrophoresis. Immuno-sorbents were also prepared to isolate IgG involved in this reaction: the latter turned out to be slow-migration IgG. Agarose-agar electroimmunoprecipitation between treponema antigens and sera of syphilitic subjects supplies possibilities for diagnosis and research in the field of treponema antigens and in the formation of antibodies in the syphilitic disease.

Syphilis is still a quite common infection often lacking clinical symptoms and sometimes ignored. Serological tests have peculiar importance in order to settle the diagnosis and therapy. Traditional tests as VDRL and TPHA cannot clearly define the clinical pattern because these tests remain positive for a long period of time. Moreover they can prove the recovery of the patients only if they continue to give low titres. The immunofluorescence test FTA ABS, that raised interest at its outset, has low sensitivity against IgM specific antibodies and defines serological state of patients only in 50% of the cases. The reading of this test remains subjective. The authors intend to verify the importance to detect the IgM specific antibodies to assume medical and legal decisions in unknown subjects, without clinical knowledge. 20,000 sera of normal subjects and of risk group have been assayed. Specific IgM are absent in 60 clinically recovered subjects with VDRL and TPHA still positive, specific IgM are present in 15 cases of Syphilis under treatment and also in 15 subjects with unknown Syphilis. The results show that: 1) IgM specific antibodies for Syphilis are not detectable in patients under a long term antibiotic treatment while the traditional serological tests (VDRL, TPHA) are positive; 2) they are present in patients under treatment with still active infection; 3) they are also present in patients with ignored infection, never treated. In conclusion the Authors consider important to include in the panel of Syphilis testing new assays for the detection of specific IgM antibodies. This is particularly important in subjects under treatment and also in unknown subjects.