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    Syphilis Assessment and Treatment Crash Course

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    Jessica Moore

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    Syphilis Assessment and Treatment Crash Course

    Uploaded by

    Jessica Moore
    13 views2 pages

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    Syphilis assessment and treatment crash course

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    13 views2 pages

    Syphilis Assessment and Treatment Crash Course

    Uploaded by

    Jessica Moore

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
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    Syphilis assessment and treatment crash course

    Credit to: Dr. Shira Heisler, M.D. Medical Director Detroit Public STD Clinic; UTD

    Syphilis

    Asymptomatic Symptomatic

    Early latent Late latent:


    - RPR reactive, with prior test within 1 year - Either no documented history of 1*: visible chancre, or
    that is either RPR NR 2*: rash palms/soles
    - or lower titer RPR that is reactive but
    Syphilis mouth ulcers
    lower than original titer - or no (+) results within 1 year

    Treatment: 3 weekly Tx: 1 dose PCN G (IM) Tx: 1 dose PCN G (IM)
    Treatment: 1 dose PCN
    doses of PCN G (IM) = - State must notify - state must notify
    G (IM)
    3 total doses partners partners

    *3 = Tertiary: see below

    **: If high clinical suspicion of Syphilis, ie MSM who is a sex worker, who reports a recent chancre, but EIA and RPR negative, you still treat as if 1*

    ***: Treatment success is measured by an expected 4 fold decrease in RPR ration ie: 1:16 => 1:4; following tx: EIA will be + lifelong
    Reverse Syphilis Testing Algorithm

    - DMC was first to do it in the nation, now all others follow.

    Background:

    - EIA: high sensitivity, high specificity, (treponemal-specific)


    - RPR: high sensitivity, less specific than EIA because (non-treponemal ie not specific to Syphilis)
    - TPPA: high specificity, (treponemal- specific)

    EIA (+) → reflex to RPR → if RPR NR → reflex to TPPA


    Common lab result scenarios:

    - EIA (+), (-) RPR, (+TPPA); if pt is asymptomatic, treat as Late latent (3 week course PCN G IM as per above)
    - EIA (-), since EIA is highly sensitive and more specific than RPR, no need to test further
    - 1* syphilis can have (-) EIA, and (-) RPR. If high clinical suspicion, treat regardless of lab test results (1 dose PCN G IM as per above)

    Late Syphilis: Either 3* or Late latent

    - Tertiary aka 3*– i.e. symptomatic and involving CV system or skin/subcutaneous tissues
    o Tx: LP to assess for neurosyphilis
    o If neurosyphilis not present: PCN G 1X/week x 3 weeks. If cardiac involvement, Tx does not reverse disease but may halt progressions

    Neurosyphilis: Can occur at ANY TIME during syphilis infxn.

    - Early: ocular disease, cranial n. dysfxn, especially VIII, and V involvement, or meningitis.
    - Later: dementia [general paresis] and tabes dorsalis (loss of coordination of movement)
    - If Neurosyphilis is present: Tx: IV PCN G (*note IV not IM), and 3 to 4 million units Q4H x 10-14 days) *note dose is larger than other forms of syphilis (3 to 4 million
    vs 2.4 million units IM)
    - Adequate response — A fourfold decline in the nontreponemal titer, equivalent to a change of two dilutions (eg, from 1:16 to 1:4 or from 1:32 to 1:8), is
    considered to be an acceptable response to syphilis therapy. Over time, most patients successfully treated for syphilis experience seroreversion; however, some
    remain serofast lifelong.

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