Syphilis cases have surged 42% in the US, making it critical for emergency physicians to recognize and treat this "great masquerader." In this episode, hosts Sam Ashoo and Dr. T.R. Eckler break down the January 2026 Emergency Medicine Practice article on syphilis diagnosis and management. They cover the rising prevalence in high-risk populations, the four clinical stages (primary, secondary, latent, and tertiary), special presentations like neurosyphilis and congenital syphilis, and practical diagnostic approaches. With a national penicillin shortage, they discuss alternative treatment options including doxycycline and post-exposure prophylaxis. The conversation also addresses the dark history of the Tuskegee Study and its lasting impact on medical ethics. Whether you're seeing more cases in your ED or want to sharpen your diagnostic skills, this episode provides actionable insights for frontline providers.

[0:00] Opening/Introduction

[0:11] Host Welcome & Resources

[0:50] Episode Introduction

[1:30] Epidemiology & Rising Cases

[4:30] Risk Factors & Screening

[6:30] Pathophysiology & Transmission

[9:30] Primary Syphilis

[12:30] Secondary Syphilis

[15:30] Tertiary & Latent Syphilis

[18:30] Neurosyphilis

[22:30] Congenital Syphilis

[25:30] Ocular & Otic Syphilis

[28:30] Differential Diagnosis & Pre-hospital Care

[31:30] History & Physical Examination

[34:30] Diagnostic Testing Overview

[38:30] Testing Details & Titers

[41:30] Treatment: Penicillin & Alternatives

[43:30] Closing