Adult Syphilis: A Narrative Review of Clinical Insights and Public Health Implications in Urology

Syphilis continues to pose a major global public health concern, with more than 7 million cases reported worldwide in 2022, and its incidence continues to rise in numerous regions. In Korea, the shift from sentinel to universal notification in 2024 has revealed a markedly greater disease burden, particularly among men who have sex with men and among younger adults, underscoring changing epidemiological patterns and the urgent need for revised control strategies. In urological practice, syphilis presents with a wide range of often misleading symptoms, including painless genital ulcers, urethritis, and sexual dysfunction, that frequently resemble other genitourinary disorders and complicate diagnostic evaluation. Accurate identification relies on integrating a thorough clinical assessment with serologic testing while remaining alert to diagnostic challenges such as early latent infection, serofast states, and human immunodeficiency virus coinfection. Penicillin G remains the mainstay of therapy, with treatment regimens tailored to the stage of disease and to the presence or absence of central nervous system involvement. Effective partner notification, targeted screening, and consistent follow-up are essential to prevent reinfection and limit further transmission. At a public health level, a multifaceted strategy—strengthened surveillance systems, focused testing in high-risk populations, and embedding syphilis screening within broader sexually transmitted infection care frameworks—is critical to curbing its resurgence. In summary, prompt recognition, adherence to evidence-based management, and coordinated public health measures, together with ongoing advances in diagnostics and prevention, remain fundamental to reducing the continued spread of syphilis and mitigating its impact on both individual and population health.