FUO and Syphilis
In summary, syphilis is an uncommon etiology for fever of unknown
origin. Evidence-based clinical resources, including UpToDate and
American Family Physician, do not thoroughly discuss syphilis in the
differential diagnosis of FUO1,2,8. Extensive
literature search reveals minimal and largely outdated case reports for
this duo9,10. In such case reports, syphilis was
similarly not discovered as the FUO etiology until multiple weeks of
clinical workup.
Given this increasing incidence of syphilis, physicians need to remain
vigilant. In addition, the stigma associated with this diagnosis may
make patients reticent to provide relevant historical data. When
considering the risk factors for syphilis, many patients belonging to
these stigmatized populations are also medically underserved. Physicians
bear the responsibility of investigating this diagnosis, while obtaining
a history in a patient-sensitive manner. Treatment for this condition is
simple and effective, whereas the sequelae of untreated syphilis may be
catastrophic.