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CLINICAL MICROBIOLOGY REVIEWS, Jan. 2006, p. 29–49 0893-8512/06/$08.00 0 doi:10.1128/CMR.19.1.29–49.2006 Copyright © 2006, American Society for Microbiology. All Rights Reserved.

Vol. 19, No. 1

Biological Basis for Syphilis
Rebecca E. LaFond1 and Sheila A. Lukehart1,2*
Departments of Pathobiology1 and Medicine,2 University of Washington, Seattle, Washington INTRODUCTION.........................................................................................................................................................29 OVERVIEW OF THE NATURAL HISTORY OF SYPHILIS.................................................................................30 Primary Syphilis.......................................................................................................................................................30 Secondary Syphilis....................................................................................................................................................31 CNS Involvement ......................................................................................................................................................31 Latent Syphilis..........................................................................................................................................................31 Tertiary Syphilis........................................................................................................................................................32 Gumma...................................................................................................................................................................32 Cardiovascular syphilis........................................................................................................................................32 Late neurological complications.........................................................................................................................32 Congenital Syphilis...................................................................................................................................................32 BIOLOGY OF T. PALLIDUM.....................................................................................................................................33 Limited Metabolic Capacity....................................................................................................................................33 In Vivo and In Vitro Growth of T. pallidum..........................................................................................................33 Paucity of Recognized Virulence Factors..............................................................................................................34 INVASION .....................................................................................................................................................................34 Attachment.................................................................................................................................................................35 Motility.......................................................................................................................................................................35 Chemotaxis ................................................................................................................................................................36 INFLAMMATION AND IMMUNE RESPONSE.....................................................................................................36 Inflammation .............................................................................................................................................................36 Dendritic Cells ..........................................................................................................................................................37 Cytokine...