Take a deeper dive into our peer-reviewed emergency medicine content with the EMplify podcast. Join hosts Sam Ashoo, MD and T.R. Eckler, MD for educational, conversational reviews of current evidence guaranteed to help you make your best clinical decisions. Each high-yield episode gives you practical, time-tested guidance from practicing emergency medicine clinicians and subject-matter experts. Listen and learn!
In this episode, Sam Ashoo, MD and T.R. Eckler, MD discuss the Januray 2026 Emergency Medicine Practice article, Emergency Department Diagnosis and Management of Patients With Syphilis
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.
Timestamps
00:00 – Introduction and welcome
02:15 – Epidemiology: Why syphilis cases are surging
06:30 – High-risk populations and screening recommendations
10:45 – Pathophysiology of Treponema pallidum
14:20 – Clinical stages: Primary syphilis and the chancre
18:40 – Secondary syphilis: The classic rash presentation
24:15 – Tertiary syphilis and cardiac complications
28:50 – Neurosyphilis: Meningitis, cranial nerve deficits, and stroke-like symptoms
34:10 – Congenital syphilis: Rising cases and screening importance
38:25 – Ocular and otosyphilis presentations
42:00 – Diagnostic approach: VDRL, RPR, and treponemal tests
47:30 – Interpreting titers and fourfold changes
51:15 – Dark field microscopy (“the coolest lab job”)
54:40 – Treatment: Benzathine penicillin G and the national shortage
59:20 – Alternative treatments: Doxycycline and ceftriaxone
1:03:45 – Jarisch-Herxheimer reaction explained
1:07:30 – Partner management and contact tracing
1:11:00 – Post-exposure prophylaxis: The “Doxy-PEP” protocol
1:15:20 – Historical context: Tuskegee Study and Guatemala experiments
1:22:45 – Emerging therapies and future directions
1:26:10 – Five key practice-changing takeaways
1:29:00 – Closing remarks and CME information
Subscribers, take the CME test here.
Emergency Medicine Residents, get your free subscription by writing resident@ebmedicine.net
In this episode, Sam Ashoo, MD and T.R. Eckler, MD discuss the Januray 2026 Emergency Medicine Practice article, Emergency Department Diagnosis and Management of Patients With Syphilis
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.
Timestamps
00:00 – Introduction and welcome
02:15 – Epidemiology: Why syphilis cases are surging
06:30 – High-risk populations and screening recommendations
10:45 – Pathophysiology of Treponema pallidum
14:20 – Clinical stages: Primary syphilis and the chancre
18:40 – Secondary syphilis: The classic rash presentation
24:15 – Tertiary syphilis and cardiac complications
28:50 – Neurosyphilis: Meningitis, cranial nerve deficits, and stroke-like symptoms
34:10 – Congenital syphilis: Rising cases and screening importance
38:25 – Ocular and otosyphilis presentations
42:00 – Diagnostic approach: VDRL, RPR, and treponemal tests
47:30 – Interpreting titers and fourfold changes
51:15 – Dark field microscopy (“the coolest lab job”)
54:40 – Treatment: Benzathine penicillin G and the national shortage
59:20 – Alternative treatments: Doxycycline and ceftriaxone
1:03:45 – Jarisch-Herxheimer reaction explained
1:07:30 – Partner management and contact tracing
1:11:00 – Post-exposure prophylaxis: The “Doxy-PEP” protocol
1:15:20 – Historical context: Tuskegee Study and Guatemala experiments
1:22:45 – Emerging therapies and future directions
1:26:10 – Five key practice-changing takeaways
1:29:00 – Closing remarks and CME information
👉 Subscribers, take the CME test here.
✨ Emergency Medicine Residents, get your free subscription by writing resident@ebmedicine.net
Sam Ashoo, MD, FACEP, is board certified in emergency medicine and clinical informatics. He serves as EB Medicine’s editor-in-chief of interactive clinical pathways and FOAMEd blog, and host of EB Medicine’s EMplify podcast. Follow him below for more…
